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SSRI-Antiplatelet Bleeding Interaction — SCE Neurology MCQ

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ModerateCerebrovascular DiseaseSSRI-Antiplatelet Bleeding InteractionSCE Neurology

A 60-year-old man with a right MCA stroke has developed post-stroke depression (PHQ-9 score 20) and is started on sertraline. He is also on aspirin 75 mg for secondary stroke prevention. What interaction should be considered?

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Correct answer: C — SSRIs increase the risk of bleeding when combined with antiplatelet agents — monitor for GI bleeding and consider gastroprotection

SSRIs (including sertraline) inhibit serotonin reuptake in platelets, impairing platelet aggregation. When combined with antiplatelet agents (aspirin, clopidogrel), the bleeding risk (particularly GI haemorrhage) is increased. This does not contraindicate the combination (the depression should be treated), but the clinician should: consider gastroprotection (PPI), monitor for GI symptoms, and warn the patient about bleeding signs. A: There is a clinically relevant interaction. C: SSRIs do not reduce aspirin efficacy. D: Serotonin syndrome requires serotonergic drug combinations, not aspirin. E: The combination is not absolutely contraindicated.

Reference: BNF Drug Interactions; NICE CG90 Depression; RCP Stroke Guidelines