Influence of pre‐operative use of serotonergic antidepressants (SADs) on the risk of bleeding in patients undergoing different surgical interventions: a meta‐analysis

Abstract

Preoperative SADs use is associated with increased bleeding risk with respect to requirement of transfusion; nevertheless, the results should not be generalized to all surgical groups. The divergence between bleeding risk and mortality in CABG surgery patients needs further evaluation.

Serotonergic Antidepressants Are Associated with Increased Blood Loss and Risk for Transfusion in Single-Level Lumbar Fusion Surgery

“…The differences in effect size can be explained by variations in study design. Similar to other studies [ 7 17 18 19 ], our results indicate that only serotonergic antidepressants with high affinity for serotonin reuptake transporters, such as SSRI, can have an effect on platelet action. Other antidepressants, such as SNRI with low affinity for serotonin transporters, did not show this effect in our study, nor other studies [ 7 17 18 19 ].…”

“…Patients on serotonergic antidepressants were found to have an increased blood loss when undergoing general, orthopedic and plastic surgery in several different studies [ 6 7 17 18 ]. In patients undergoing percutaneous endoscopic gastrostomy, intake of SSRI increased the risk of post-procedural bleeding 4-fold, while aspirin and clopidogrel did not [ 18 ].…”

“…Serotonin is known to enhance platelet activation, and serotonergic antidepressants have been demonstrated to deplete intracellular serotonin stores, thereby impairing platelet aggregation [ 4 5 ]. Meta-analyses have demonstrated an increase in perioperative bleeding and transfusion rates in general, plastic, and orthopedic surgery patients receiving these serotonergic medications [ 6 7 ]. Allogeneic blood transfusions have been associated with increased risk of sepsis, return to operating room, surgical site infection, pulmonary embolism, as well as increased length of stay in lumbar fusion surgery [ 8 ].…”

Perioperative management of patients with mental diseases

“…При терапии СИОЗС отмечается повышенный риск геморрагических осложнений [9] и периоперационной кровопотери, превышающей обычную [10] и требующей проведения трансфузии эритроцитов [10][11][12][13]. Риски возникновения кровотечения особенно велики при использовании препаратов с высокой и средней активностью в отношении ингибирования серотонинового транспортера (5-НТТ) [14,15].…”

“…Подчеркивается необходимость оценки степени «риск/польза» в отношении отмены или продолжения приема СИОЗС перед оперативным вмешательством. Необходимо взвесить степень риска геморрагических и других витальных осложнений при продолжении их приема и вероятности рецидива психического расстройства в случае отмены [10][11][12][13]. В большинстве случаев рекомендуют продолжить периоперационную терапию СИОЗС и атипичными антидепрессантами в связи с риском синдрома отмены, особенно при использовании препаратов с коротким периодом полувыведения [3,[87][88][89][90].…”