Effect of selective serotonin re-uptake inhibitors (SSRIs) on functional outcome in patients with acute ischemic stroke treated with tPA.

Background: Selective serotonin re-uptake inhibitors (SSRIs) may have therapeutic potential in the treatment of ischemic stroke by effects on neuronal cell survival and the plasticity of brain processes. In the present study, we investigated whether prior treatment with a SSRI is associated with more favorable functional outcome in a cohort of patients with acute ischemic stroke treated with tissue plasminogen activator (tPA).

Methods: In a prospective observational cohort study of 476 acute ischemic stroke patients treated with tPA we investigated the relationship between prior SSRI treatment and functional outcome at 3 months. Ischemic stroke subtypes were defined according to the Oxfordshire Community Stroke Project Classification. Favorable outcome was defined as a modified Rankin Scale score
Results: In the cohort of 476 patients, 22 (5%) patients used a SSRI at stroke onset. At 3 months, 217 (46%) patients had a favorable outcome of whom 9 (41%) on SSRI treatment and 208 (46%) not using SSRIs (p=0.65). In a multivariable analysis SSRI treatment showed a trend to association with unfavorable outcome (OR 0.4, 95% CI 0.14-1.13, p=0.08). In the 376 patients with cortical stroke, SSRI treatment was associated with an unfavorable outcome (OR 0.17, 95% CI 0.04-0.73, p=0.017).

Conclusion: Our data suggest that in patients with acute ischemic stroke treated with tPA, prior SSRI use may be associated with a less favorable outcome, especially in cortical stroke.