Moderate
Acetylsalicylic acid × fluvoxamine
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×SSRI
Mechanism
SSRIs block serotonin reuptake into platelets, impairing primary haemostasis. Additively with aspirin's antiplatelet effect: upper GI bleeding risk roughly doubles.
Symptoms
Gum bleeding, epistaxis, bruising without trauma. Severe cases: GI bleeding.
Management
The combination is acceptable at low aspirin doses (75–100 mg as cardioprotection). PPI cover with pantoprazole is mandatory. Alternative antidepressants with minimal platelet effect: mirtazapine or agomelatine.