Serotonin Reuptake Inhibitors and Bleeding Risks in Major Orthopedic Procedures

Tavakoli, Hamid; DeMaio, Marlene; Wingert, Nathaniel C.; Rieg, Thomas S.; Cohn, Julie; Balmer, Russell P.; Dillard, Marie A.

doi:10.1016/j.psym.2012.05.001

Cited by 16 publications

(11 citation statements)

References 37 publications

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“…The following salient characteristics are noted: Of the seven studies of orthopedic surgeries – five for hips (36,39,40,41,42), one for all orthopedic procedures (37) and one for spinal fusion (38) − 6 of 7 report significantly higher rates of either intra-operative blood loss or need for transfusions in SSRI users compared with non-users.Of the four studies of CABG, three reported no increased bleeding issues with SSRI users (43,44,45) and one reported an increased need for transfusion in the SSRI user but no increased rate of reoperation due to bleeding (46). Of note both the SSRI and non-groups received anti-platelet agents during the perioperative period.…”

Section: Ssris and Peri-operative Or Post-partum Bleedingmentioning

confidence: 99%

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Selective Serotonin Reuptake Inhibitors and Operative Bleeding Risk

Roose

Rutherford

2016

J Clin Psychopharmacol

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Objective To review the data on the effect of selective serotonin reuptake inhibitors (SSRIs) on bleeding during or after operative procedures and to offer guidelines for clinical management. Data Sources Search of PUBMED and Medline for all articles in English from 1990–2016 with key words depression, antidepressants, bleeding, platelets, and operation. Study Selection: Studies were included if they reported information on bleeding complications during operative or childbirth procedures in patients taking antidepressants. Data Extraction Due to the limited number and heterogeneity of studies with respect to the range of operative procedures and definition of bleeding complications, a qualitative approach was taken to summarize results rather than abstracting and aggregating data. Results The weight of the evidence is that SSRI use increases the risk of bleeding complications during and immediately after surgery. However, given the limited data we cannot estimate the risk for a given patient having a given procedure. Conclusions Clinicians must consider the risk to benefit ratio of discontinuing an SSRI before an elective operative procedure. Discontinuing SSRI medications may result in discontinuation syndrome, symptom recrudescence, or relapse of depression, while continuing an SSRI during surgery exposes patients to significant bleeding risks. Antidepressant prescribers must be cognizant of and take responsibility for discussing this potential problem and considering different options. This issue must also be the responsibility of the doctor performing the procedure, but frequently it will be the prescribing physician who alerts the surgeon to the potential bleeding risk associated with SSRIs.

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Section: Ssris and Peri-operative Or Post-partum Bleedingmentioning

confidence: 99%

“…Of the seven studies of orthopedic surgeries – five for hips (36,39,40,41,42), one for all orthopedic procedures (37) and one for spinal fusion (38) − 6 of 7 report significantly higher rates of either intra-operative blood loss or need for transfusions in SSRI users compared with non-users.…”

Section: Ssris and Peri-operative Or Post-partum Bleedingmentioning

confidence: 99%

Selective Serotonin Reuptake Inhibitors and Operative Bleeding Risk

Roose

Rutherford

2016

J Clin Psychopharmacol

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“…Some investigations (Grzeskowiak et al, 2015, Lindqvist et al, 2014, Palmsten et al, 2013) but not all (Lupattelli et al, 2014, Salkeld et al, 2008) have shown an association between third trimester SRI or antidepressant use and postpartum hemorrhage (PPH). In some non-pregnant populations SRI use is associated with an increased bleeding risk (Anglin et al, 2014, Hankey, 2014, Harirchian et al, 2012, Jiang et al, 2015, Tavakoli et al, 2012). The impact of SRIs on increased bleeding risk is inconsistent in non-pregnant populations as well.…”

Section: Introductionmentioning

confidence: 99%

“…The impact of SRIs on increased bleeding risk is inconsistent in non-pregnant populations as well. For example, these drugs have been associated with spontaneous gastrointestinal bleeding (Andrade et al, 2010, Lee et al, 2012) but not hemorrhage during surgical procedures (Tavakoli et al, 2012). …”

Section: Introductionmentioning

confidence: 99%

Is third trimester serotonin reuptake inhibitor use associated with postpartum hemorrhage?

Kim

Pinheiro

Luther

et al. 2016

Journal of Psychiatric Research

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As serotonin reuptake inhibitor (SRI) use may decrease platelet function, previous research has shown a relationship between SRI use and an increased risk for bruising and bleeding. The literature regarding the association between SRI use during pregnancy and increased bleeding at delivery, referred to as postpartum hemorrhage (PPH), is mixed. In secondary analyses from two prospective observational studies of pregnant women with mood disorders, 263 women were exposed to an SRI (n=51) or not (n=212) in the third trimester. To be precise, we used the terminology estimated blood loss (EBL) > 600 cc rather than the term PPH because the current definition of PPH differs. The occurrence of EBL > 600 cc was determined using the Peripartum Events Scale (PES) completed from obstetrical records by a blinded medically trained member of the study team. EBL > 600 cc occurred in 8.7% of women in this cohort. There was no statistically significant difference in the rates of EBL > 600 cc in the 24 hours after delivery in women taking SRIs during the third trimester (9.8%) compared to non-exposed women (8.5%). Utilizing generalizing estimating equations, the odds of EBL > 600 cc in each group were not significantly different (OR 1.17, CI-0.41-3.32, p=0.77). When the SRI group was limited to women with exposure at the time of delivery, the difference in the odds of EBL > 600 cc was unchanged (OR 1.16, CI=0.37-3.64, p=0.79). In population, both third trimester and use at delivery of SRIs during pregnancy was not associated with an increased risk of excessive blood loss.

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“…For orthopedic surgical patients, studies have shown conflicting results as one study found an increase in perioperative blood loss but without a corresponding increase in transfusion rate, while others found the risk of transfusion to be higher in SSRI users . In addition, a recent study in total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients showed no difference in perioperative bleeding or transfusion rate between SSRI users and nonusers . Consequently, further detailed data for the potential detrimental effects of SSRIs in the perioperative period is needed compared with the risks of discontinuation of therapy (discontinuation syndrome, relapse of psychiatric symptoms, pain).…”

mentioning

confidence: 99%