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Sertraline May Enhance Antiplatelet Activity in Patients With Acute Coronary Syndromes

The selective serotonin reuptake inhibitor (SSRI) sertraline may benefit patients with acute coronary syndromes (ACS) because of its anti-platelet activity.

According to Victor L. Serebruany MD, PhD, with the Sinai Center for Thrombosis Research at Johns Hopkins University, Baltimore, United States, and colleagues, enhanced platelet activation is thought to be one of the mechanisms underlying the association between depression after acute coronary syndromes. In addition, SSRIs are known to inhibit platelet activity.

The researchers assessed the release of established platelet/endothelial biomarkers in patients treated with sertraline versus placebo in the Sertraline AntiDepressant Heart Attack Randomised Trial (SADHART).

Participants were randomised to sertraline (n=28) or placebo (n=36) and plasma samples were collected at baseline, week 6, and week 16. Various markers of platelet/endothelial biomarkers were measured, including platelet factor 4, and beta-thromboglobulin. Patients were allowed to take anticoagulants, aspirin, and ADP-receptor inhibitors.

Treatment with sertraline was associated with a decreased release of platelet/endothelial biomarkers compared to treatment with placebo. These differences were significant for beta-thromboglobulin (p=0.03) at weeks 6 and 16 and P-selectin (p=0.04) at week 16.

"Repeated-measures ANOVA revealed a significant advantage for sertraline versus placebo for diminishing E-selectin and beta-thromboglobulin concentrations across the entire treatment period," the researchers note.

They point out that even though some patients were taking antiplatelet regimens including aspirin and ADP-receptor blockers, treatment with sertraline in depressed post-ACS patients was still associated with decreased platelet activation.

"Thus, anti-platelet properties of sertraline differ from those of aspirin, dipyridamole, clopidogrel, and glycoprotein IIb/IIIa inhibitors, the pathways of which are well identified."

They suggest that sertraline may initially target platelet serotonin receptors and then indirectly affect major platelet functions, such as adhesion, aggregation, secretion, or receptor expression.

According to the researchers, "antiplatelet properties of SSRIs might represent an attractive additional advantage for patients with depression and comorbid coronary artery disease and ischaemic stroke."
Circulation 2003 Aug 11;[Epub ahead of print]. "Platelet/Endothelial Biomarkers in Depressed Patients Treated With the Selective Serotonin Reuptake Inhibitor Sertraline After Acute Coronary Events. The Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy"

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