Relationship of Serotonergic Antidepressants and Need for Blood Transfusion in Orthopedic Surgical Patients

Movig, Kris L. L.; Janssen, Michiel W. H. E.; Malefijt, J. de Waal; Kabel, P. J.; Leufkens, Hubert G. M.; Egberts, Toine C. G.

doi:10.1001/archinte.163.19.2354

Cited by 150 publications

(129 citation statements)

References 36 publications

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“…Since then, several other studies have reported an association between SSRI use and spontaneous upper gastrointestinal hemorrhage [8] . A case-control study by Meijer et al, [4] observed a 2.6 fold increased risk of gastrointestinal bleeding events in patients receiving SSRI medications and the findings of this study were similar to the initial 1999 report of de Abajo et al [7] Platelet aggregation is essential for hemostatic thrombus formation, and this process requires the release of serotonin from the platelets [1,9] . Serotonin, is a neurotransmitter hormone (5-hydroxytryptamine, 5-HT), which is primarily stored in the blood platelets (99%), in the enterochromaffin cells of the intestines, and the neurons in the central nervous system [1,9,10] .…”

Section: Introductionsupporting

confidence: 85%

“…There was no significant difference in the three outcome measures of change in hematocrit, estimated blood loss, and perioperative transfusion requirements between patients who used serotonergic antidepressants and those who did not. In the study of Moving et al [4] . The study population consisted of patients who underwent a variety of orthopedic surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…Although known to be safe, several case reports and observational studies noted significant associations between serotonergic antidepressant use and abnormal bleeding events such as ecchymoses, hematoma, purpura, epistaxis, vaginal bleeding, upper gastrointestinal bleeding, intracranial bleeding, and perioperative bleeding [3,4] . Clinical reports of increased risk of abnormal bleeding in patients using these drugs emerged soon after the introduction of this class of agents in the 1990s [5] .…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, few studies have researched the proposed relationship between the uses of serotonergic antidepressant medications and increased surgical bleeding, and data on this association thus far is inconclusive and conflicting. A study by Movig et al in (2003) concluded that SSRI use in patients undergoing orthopedic surgery is associated with a 3.7 fold increased risk of bleeding and subsequent necessity for blood transfusions [4] . Similar results were presented in a study of patients undergoing spinal surgery, by Sayadipour et al in 2012, [15] which found a statistically significant higher blood loss in those taking serotonergic antidepressants compared to the control group.…”

Section: Introductionmentioning

confidence: 99%

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Case of tuberculosis acromioclavicular joint presenting as lytic lesion in lateral end clavicle: rare case report

Pandey¹,

Pawar²,

Verma³

2015

Int. J. Orthop. Sci.

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Background: Serotonergic antidepressants inhibit platelet aggregation, and use of these drugs has been associated with adverse bleeding events. The objective of this study was to determine the association of preoperative use of serotonergic antidepressants and perioperative bleeding in patients undergoing total knee arthroplasty. Methods: A retrospective analysis was conducted of 80 patients who underwent elective primary total knee arthroplasty in a large hospital. The index group included 40 patients who used serotonergic antidepressants in the preceding 4 weeks prior to surgery, and the reference group included 40 patients who were nonusers. The primary outcome was the change in hematocrit; and the secondary outcomes were the amount of estimated blood loss and the requirement for blood transfusion. Results: Comparing the patients who were using SSRIs and those who were not, no statistically significant difference was observed in the level of the three dependent variables of Hct change, estimated blood loss and transfusion units (p > .05). The effect of the use of SSRI on preoperative hemoglobin and hematocrit levels, however, was significant (p = .027; p = .023, respectively), as patients who used SSRI had significantly lower levels of preoperative hemoglobin and preoperative hematocrit. Conclusions: This study concluded that patients undergoing total knee arthroplasty who continued to use serotonergic antidepressants did not show a statistically significant perioperative blood loss based on the three outcome measures of change in hematocrit, blood transfusion needs, and estimated blood loss.

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Section: Introductionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Case of tuberculosis acromioclavicular joint presenting as lytic lesion in lateral end clavicle: rare case report

Pandey¹,

Pawar²,

Verma³

2015

Int. J. Orthop. Sci.

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“…In spite of the encouraging safety profile of SSRIs, there have been several studies suggesting that SSRIs may cause bleeding abnormalities in orthopedic procedures, mostly following hip and knee arthroplasty [3,4]. A possible mechanism for this effect involves the inhibition of serotonin reuptake into platelets, as serotonin weakly potentiates platelet aggregation and hemostasis [5].…”

Section: Introductionmentioning

confidence: 99%

Antidepressants and the risk of abnormal bleeding during spinal surgery: a case–control study

et al. 2012

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Introduction Antidepressant medications are widely used by patients requiring spinal surgery. In spite of a generally favorable safety profile of newer antidepressants, several prior studies have suggested an association between use of serotonergic antidepressants and excessive bleeding. This study was designed to determine if there was any association between antidepressant use and the risk of excessive intraoperative blood loss during spinal surgery, and whether particular types of antidepressants were specifically associated with this increased blood loss. Materials and methods A retrospective case control study was conducted utilizing a population of 1,539 patients who underwent elective spinal fusion by a single surgeon at one medical center. Of the included patients, 213 used antidepressant medication and 1,326 patients did not use any type of antidepressant medication. Of patients taking antidepressants, 37 patients were excluded based on exclusion criteria, leaving 176 patients suitable for inclusion. The study group (176 patients) consisted of all patients who used an antidepressant medication for at least a 2-week period prior to spinal surgery. A control group of 352 patients were assembled from a random sample of 1,326 patients operated on by the same surgeon during the same time period in a two-to-one ratio with study group. Intraoperative blood loss was the primary outcome variable and was compared between the study and control group and between individuals in the study group taking serotonergic (SSRIs or SNRIs) or non-serotonergic antidepressants. Other variables, including length of hospital stay and surgical category, were also collected and analyzed separately. Results Overall, the mean blood loss (BL) for the antidepressant group was 298 cc, 23% more than the 241 cc lost by the procedure-and level-matched control group (p = 0.01). Patients taking serotonergic antidepressants also had statistically significant higher blood loss than the matched control group as a whole (334 vs. 241 cc, p = 0.015). This difference was also found in subgroups of patients who underwent anterior cervical discectomy and fusion, lumbar instrumented fusion, or anterior/posterior lumbar fusion. Blood loss was also higher in the subgroup of patients taking bupropion (708 cc, p = 0.023) compared with the control group. The mean length of hospital stay

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Association of Risk of Abnormal Bleeding With Degree of Serotonin Reuptake Inhibition by Antidepressants

Meijer¹,

Heerdink²,

Nolen³

et al. 2004

Arch Intern Med

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Relationship of Serotonergic Antidepressants and Need for Blood Transfusion in Orthopedic Surgical Patients

Abstract: Use of serotonergic antidepressants is associated with an increased risk of bleeding and subsequent need for blood transfusion during orthopedic surgery. The bleeding could be attributed to inhibition of serotonin-mediated platelet activation.

Cited by 150 publications

References 36 publications

Case of tuberculosis acromioclavicular joint presenting as lytic lesion in lateral end clavicle: rare case report

Case of tuberculosis acromioclavicular joint presenting as lytic lesion in lateral end clavicle: rare case report

Antidepressants and the risk of abnormal bleeding during spinal surgery: a case–control study

Association of Risk of Abnormal Bleeding With Degree of Serotonin Reuptake Inhibition by Antidepressants

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