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Coagulation/Bleeding
Some studies show that SRIs may alter bleeding time via altered 5-HT levels in platelets. Serotonin functions in platelet activation and promotes coagulant activities. While studies have mixed conclusions, most agree that when SRIs are taken along with other drugs acting on coagulation (particularly warfarin and acenocoumarol), the SRIs enhance anticoagulant actions (leading to more bleeding time).
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References
Marazziti, D., Mucci, F., Tripodi, B., Carbone, M. G., Muscarella, A., Falaschi, V., & Baroni, S. (2019). Emotional Blunting, Cognitive Impairment, Bone Fractures, and Bleeding as Possible Side Effects of Long-Term Use of SSRIs. Clinical neuropsychiatry, 16(2), 75–85.
Hergovich, N., Aigner, M., Eichler, H. G., Entlicher, J., Drucker, C., & Jilma, B. (2000). Paroxetine decreases platelet serotonin storage and platelet function in human beings. Clinical Pharmacology & Therapeutics, 68(4), 435-442. https://doi.org/10.1067/mcp.2000.110456
McCloskey, D. J., Postolache, T. T., Vittone, B. J., Nghiem, K. L., Monsale, J. L., Wesley, R. A., & Rick, M. E. (2008). Selective serotonin reuptake inhibitors: measurement of effect on platelet function. Translational research : the journal of laboratory and clinical medicine, 151(3), 168–172. https://doi.org/10.1016/j.trsl.2007.10.004
Ross, S. B., Aperia, B., Beck-Friis, J., Jansa, S., Wetterberg, L., & Aberg, A. (1980). Inhibition of 5-hydroxytryptamine uptake in human platelets by antidepressant agents in vivo. Psychopharmacology, 67(1), 1–7. https://doi.org/10.1007/BF00427588
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