Influence of preoperative use of serotonergic antidepressants (SADs) on the risk of bleeding in patients undergoing different surgical interventions: a metaanalysis (original) (raw)
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Perfusion, 2018
Introduction: Depressive illness has a high prevalence in patients undergoing coronary artery bypass graft surgery (CABG). The first line treatment for depression are selective serotonin reuptake inhibitors (SSRIs) which inhibit serotonin reuptake in the presynaptic neuronal membrane and uptake by platelets, inhibiting subsequent serotonin-mediated platelet activation. This presents a theoretically increased risk of bleeding and subsequent postoperative mortality. This review aims to investigate the effects of SSRIs on postoperative bleeding, defined as the need for transfusions and reoperation for bleeding, as well as 30-day mortality in patients undergoing CABG. Method: Four hundred and thirty-seven papers were screened with seven meeting the full inclusion criteria. Results: Meta-analysis demonstrated that SSRI use increased the risk of red blood cell transfusion (odds ratio (OR) = 1.15; 95% confidence interval (CI): 1.06-1.26), but resulted in no difference in the rate of re-operation for bleeding (OR = 1.07; 95% CI: 0.66-1.74). SSRI use had no effect on the rates of platelet (OR = 0.93; 95% CI: 0.79-1.09) or fresh frozen plasma (OR = 0.96; 95% CI: 0.74-1.24) transfusion nor on the mortality rate (OR =1.03; 95 CI: 0.90-1.17). Conclusion: This review demonstrates that SSRIs are largely safe in cardiac surgery as no increase in mortality was observed. However, there is a significantly raised chance of red blood cell transfusion. The heterogeneous nature of the current evidence base highlights the need for further research into SSRIs and whether any effect on patient outcomes in cardiac surgery occurs.
Association of Selective Serotonin Reuptake Inhibitors with Transfusion in Surgical Patients
Anesthesia and analgesia, 2016
The clinical relevance of chronic exposure to selective serotonin reuptake inhibitors (SSRIs) to transfusion in surgical patients is unclear. We conducted a prospective cohort study involving patients undergoing cardiac, vascular, spinal, and intracranial surgery at 2 academic medical centers. Medication use, demographics, comorbidities, and laboratory values were determined at baseline by patient interview and review of medical records. The primary outcome was transfusion of any hemostatic allogeneic blood product (i.e., fresh frozen plasma, platelets, and/or cryoprecipitate) through postoperative day 2. The study sample consisted of 767 patients; 364 patients (47.5%) underwent cardiac surgery and the remainder underwent noncardiac surgery. Eighty-eight patients (11.5%) used SSRIs preoperatively. Among cardiac patients, the absolute number of allogeneic transfusions was higher for SSRI users than nonusers (2 [0-6] vs 0 [0-2], median [25%-75%], respectively, P = 0.008), and a simila...
Archives of Internal Medicine, 2003
Background: Several reports of various bleeding problems associated with the use of serotonergic antidepressants have been published. However, no information concerning the effect of these drugs on perioperative blood loss and blood transfusion requirements during orthopedic surgery is available. The objective of this study was to determine the association between use of serotonergic antidepressants and perioperative blood loss and transfusion in orthopedic surgical patients.
Heart, Lung and Circulation, 2012
Methods: 4136 patients underwent CABG surgery between January 1996 and December 2008 and 105 (2.5%) were SSRI/SNRI users. Bleeding events included platelet, fresh frozen plasma and packed red blood cell transfusion, reoperation for bleeding and gastrointestinal bleeding. In-hospital morbidity included renal failure, stroke, ventilation >24 h, deep sternal wound infection, reoperation (any cause), myocardial infarction and mortality.
Basic & Clinical Pharmacology & Toxicology, 2014
In vitro studies have shown that selective serotonin reuptake inhibitors inhibit platelet aggregation. It is well documented that SSRIs cause serious gastrointestinal bleeding, but studies on other bleeding manifestations have been equivocal. Our objective was to determine a possible association between use of serotonergic antidepressants (SA) and perioperative bleeding during hip replacements. We conducted a retrospective study between 1 January 2007 and 30 June 2012 among patients that underwent a primary unilateral uncemented total hip arthroplasty (THA). Information was collected on the observed blood loss and the need for blood transfusions among this group. We compared the blood loss between users of SA, users of non-serotonergic antidepressants (NSA) and non-users, while adjusting for potential confounders using multivariate linear regression. We indentified 1318 patients that underwent a THA in the study period. The average volume of surgical bleeding was 350 ml. The adjusted incremental blood loss associated with use of SA and NSA was 93, 95% confidence interval (38-147) ml and À50 (À125 to 25) ml compared with non-use. Only 48 subjects (3.6%) had transfusions. Use of SA was associated with an increased blood loss compared with non-users. The hypothesis that SA impairs haemostasis is supported by these results.
Desmopressin Reduces Transfusion Needs after Surgery : A Meta-analysis of Randomized Clinical Trials
Anesthesiology, 2008
Background: Perioperative pathologic microvascular bleeding is associated with increased morbidity and mortality and could be reduced by hemostatic drugs. At the same time, safety concerns regarding existing hemostatic agents include excess mortality. Numerous trials investigating desmopressin have lacked power to detect a beneficial effect on transfusion of blood products. The authors performed a meta-analysis of 38 randomized, placebo-controlled trials (2,488 patients) investigating desmopressin in surgery and indicating at least perioperative blood loss or transfusion of blood products.
Factors Associated with Excessive Postoperative Blood Loss and Hemostatic Transfusion Requirements
Survey of Anesthesiology, 1997
amount of subsequent postoperative CTD or the requirement for hemostatic blood product transfusion when these drugs were administered using a standardized dosing protocol for CPB. Furthermore, this study was designed to examine this issue in conjunction with multiple demographic and perioperative factors using a multivariate statistical analysis involving multiple blood loss and transfusion-related models. Methods After approval by our Institutional Human Studies Committee and obtaining preoperative informed consent, 487 consecutive adult patients undergoing cardiac surgery requiring CPB were prospectively enrolled in this study. Exclusion criteria consisted of: 1) emergency procedures or 2) use of antifibrinolytic drugs (aprotinin, epsilonaminocaproic or tranexamic acid). All patients were anesthetized with fentanyl30-100 pg/kg, supplemented with isoflurance 0.25-0.5 expired minimum alveolar anesthetic concentration, muscle relaxants (vecuronium lo-20 mg pancuronium lo-15 mg, or metocurine 15-20 mg), and
Turkish Journal of Clinics and Laboratory
Aim: Bleeding is a major problem in cardiac surgery, and results in a high risk of allogeneic blood transfusion associated with increased morbidity and mortality. In recent years, studies in the literature reported that desmopressin (1-deamino-8-D-arginine vasopressin, DDAVP) reduces the blood loss after surgical interventions. The aim of the present study is to analyze the effect of desmopressin and tranexamic acid on blood product use and postoperative bleeding in patients that were pretreated with P2Y12 inhibitors by cardiologists and undergone emergent coronary artery bypass grafting (CABG) surgery. Material and Methods:The prospectively collected data of 62 adult patients who underwent emergent isolated CABG surgery and pretreated with P2Y12 inhibitors by cardiologists were retrospectively reviewed. The perioperative data of the patients included their demographic data, laboratory findings, the amount of blood loss from chest tubes, the amount of blood product use, need of re-t...
The Annals of Thoracic Surgery, 2011
The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS member or an individual non-member subscription to the journal. R eoperation for bleeding, estimated to occur in 2% to 8% of cardiac surgical patients, is an undesirable event associated with increased patient morbidity, mortality, and resource utilization [1-6]. A recent investigation in coronary artery bypass grafting (CABG) revealed a 2.4% prevalence of reoperation for bleeding with an associated risk-adjusted mortality of 5.9%, compared with 2.0% for patients not returning to the operating room. Not surprisingly, those requiring reoperation received substantially more red blood cell (RBC) transfusions and component therapy [1]. Because of this linkage between reoperation and transfusion requirements, quantifying separate effects on outcomes is challenging. Therefore, primary objectives of this investigation were to determine time-related prevalence of reoperation for bleeding after cardiac surgery, to identify its risk factors, and to assess its association with postoperative morbidity while considering the concomitant risks of transfusion. Our secondary objective was to review source of postoperative bleeding found at reoperation.
Use of Serotonergic Antidepressants and Bleeding Risk in Orthopedic Patients
Anesthesiology, 2010
Background Selective serotonin reuptake inhibitors have been associated with an increased bleeding tendency. Information on the impact of a possible impaired hemostasis associated with the perioperative use of selective serotonin reuptake inhibitors is limited. This study aimed to determine the association between the perioperative use of selective serotonin reuptake inhibitors and the amount of blood loss during surgery and perioperative transfusion requirements. Methods The authors conducted a retrospective cohort study among patients who underwent elective primary total hip arthroplasty in two hospitals from the period of July 1, 2004 until July 1, 2008. The index group included all users of both serotonergic and nonserotonergic antidepressants. The reference group included a random sample (ratio 1:3) of nonusers. The primary outcome was the amount of intraoperative blood loss. The requirement for blood transfusion was a secondary outcome. The outcomes were adjusted for confoundi...