Background: Selective serotonin reuptake inhibitors (SSRIs) are believed to increase bleeding risk by interfering with platelet function. Platelets store serotonin, which plays a key role in aggregation. By inhibiting serotonin reuptake, SSRIs decrease the availability of serotonin within platelets, potentially impairing aggregation and increasing the risk of bleeding. In this study, we primarily investigated the occurrence of easy bruising (spontaneous ecchymosis) in patients with generalized anxiety or depression compared to those without. We also explored additional risk factors for spontaneous ecchymosis, including sepsis, disseminated intravascular coagulation (DIC), bone marrow transplant, iron deficiency anemia, sex, race, and acute kidney injury (AKI). Methods: We utilized the National Inpatient Sample (NIS) database from 2016 to 2022 to identify 46,400,000 hospitalized adult patients. Propensity score matching was performed to compare patients with generalized anxiety and/or depression to those without. Propensity scores were estimated using a logistic regression model that included age, sex, race, income quartile, length of stay, total hospital charges, and relevant comorbidities. After 1:1 matching, 9,045,088 patients with generalized anxiety/depression were matched to an equal number of patients without these conditions. Logistic regression analysis was conducted on the matched cohort to assess the association between generalized anxiety/depression and easy bruising (spontaneous ecchymosis), adjusting for disseminated intravascular coagulation (DIC), sepsis, bone marrow transplant, acute kidney injury, iron deficiency anemia, sex, and race. Results: The mean age was 59.23 years in the non-generalized anxiety/depression group and 57.67 years in the generalized anxiety/depression group. Females comprised 62.22% of the control group and 64.07% of the generalized anxiety/depression group. Multivariate logistic regression was performed to identify independent risk factors for easy bruising while adjusting for potential confounders. Generalized anxiety/depression was associated with a slight but statistically non-significant increase in the odds of easy bruising (OR: 1.01; p = 0.409). Disseminated intravascular coagulation (DIC) had the strongest association with easy bruising (OR: 7.19; p < 0.001), followed by bone marrow transplant (OR: 3.21; p < 0.001), acute kidney injury (OR: 1.57; p < 0.001), iron deficiency anemia (OR: 1.36; p < 0.001), and sepsis (OR: 1.35; p < 0.001). In contrast, female sex was associated with reduced odds of easy bruising (OR: 0.85; p < 0.001), as was identifying as a race/ethnicity other than White (Black, Hispanic, Asian, Native American, or Other) compared to White race (OR: 0.97; p = 0.0031). Conclusion: This large, propensity-matched analysis identified several significant risk factors for easy bruising, including DIC, bone marrow transplant, AKI, sepsis, and iron deficiency anemia. While generalized anxiety/depression was not independently associated with increased risk, our primary aim was to explore the potential link between SSRI use and easy bruising. Due to the limitations of the NIS database, which does not include medication data, we used generalized anxiety/depression as a proxy, assuming that most patients in this group are treated with SSRIs. Future studies with detailed treatment data are needed to directly assess the impact of SSRIs on bleeding risk.

This content is only available as a PDF.
2025
Sign in via your Institution