What class of medications increases the risk of bleeding when used with NSAIDs?

The correct answer is that antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can increase the risk of bleeding when used in conjunction with nonsteroidal anti-inflammatory drugs (NSAIDs). This heightened risk is primarily due to the effects of SSRIs on platelet aggregation.

NSAIDs inhibit the synthesis of thromboxane A2, which is essential for platelet activation and aggregation; however, SSRIs can impair the function of platelets by decreasing serotonin levels in platelets, which is also involved in the aggregation process. When used together, this combination can lead to an increased bleeding risk, especially in patients who may already have risk factors for bleeding, such as the elderly or those with certain medical conditions.

In contrast, antipsychotics, stimulants, and beta-blockers do not carry the same significant bleeding risk when used with NSAIDs. Antipsychotics primarily target dopamine receptors and do not significantly affect platelet function. Stimulants do not have a direct impact on bleeding risk related to platelet function, and beta-blockers primarily affect cardiovascular parameters rather than coagulation pathways. Therefore, antidepressants are the class that carries this specific risk when combined with NSAIDs.