Introduction: Selective serotonin reuptake inhibitors (SSRIs) have been implicated in contributing to recovery after acute ischemic stroke. In particular, post stroke initiation of an SSRI has been demonstrated to improve motor recovery. The role of prestroke SSRI use on functional outcomes and stroke recovery is less clear. We aimed to examine the effect of prestroke SSRI use on metrics of hospitalization and functional recovery.
Hypothesis: Pre-event SSRI therapy improves functional outcome in acute ischemic stroke.
Methods: We included 4968 consecutive patients from January 2006 to June 2015 in our local Get with the Guidelines-Stroke registry in whom the preadmission admission drug list could be extracted from an administrative research data registry. Univariate and multivariable analyses were performed to identify predictors of functional outcomes.
Results: Among 4698 ischemic strokes (740 SSRI users and 3948 nonusers) univariate analysis of SSRI use before acute ischemic stroke did not impact admission NIHSS, length of stay or rate of symptomatic hemorrhage (Table 1). Patients using SSRIs prior to their stroke were more likely to present with weakness (57% vs 47.3%, p<0.001) and have hospitalizations complicated by pneumonia (7.6% vs 5.7%, p<0.001). Moreover, pre-stroke SSRI use was associated with a negative impact on ambulatory status at discharge and discharge to home. On multivariable regression analysis, SSRI use was associated with lower likelihood of discharge to home (aOR 0.79, 95%CI 0.62, 0.997; p<0.05).
Conclusions: SSRI use preceding an acute ischemic stroke is associated with lower rates of discharge to home despite no significant increase in length of stay or NIHSS. Further studies evaluating potential confounding factors, the influence of prior SSRI use on infarct size, and longer term outcomes are warranted.