Does concomitant TKI‒SSRI use increase risk of bleeding, thrombotic events?

Patients with chronic myeloid leukaemia (CML) who are being treated with both tyrosine kinase inhibitors (TKIs) and selective serotonin reuptake inhibitors (SSRIs) do not appear to be at greater total risk of bleeding or thrombotic events than those on TKIs only, reveals a study. However, concomitant use of TKIs and SSRIs may elevate the risk of intracranial bleeding.

In this retrospective cohort study, the investigators determined the risk of bleeding or thrombosis with concurrent use of TKIs used to treat CML and SSRIs. Patients with a chronic phase CML diagnosis and who initiated TKI treatment (eg, imatinib, dasatinib, nilotinib, bosutinib, or ponatinib) after April 2016 were included.

One hundred patients met the eligibility criteria, of whom 80 were on TKIs only (median age 55 years, 40 percent female) and 20 were receiving TKI and SSRI concomitantly (median age 53.5 years, 55 percent female). Baseline characteristics were similar across all variables between the two cohorts.

Nine bleeding events and three thrombotic events occurred among patients in the TKI only group, while six bleeding events and one thrombotic event were recorded among those in the combination group. No significant between-group difference was observed in the overall rates of major bleeding (10 percent vs 4 percent; p=0.26) or thrombotic events (5 percent vs 4 percent; p=1).

However, patients in the combination group had a higher likelihood of having major intracranial bleeding events (10 percent vs 0 percent; p=0.04). In addition, a trend towards significance for minor bleeding events had been noted in this cohort (20 percent vs 7.5 percent; p=0.11).

“Further work is needed to fully assess this risk,” the investigators said.