Serotonergic antidepressants and increased bleeding risk in patients undergoing breast biopsy

Mahdanian, Artin; Looper, Karl; Bacon, Simon; Mesurolle, Benoı̂t; Meterissian, Sarkis; Rej, Soham

doi:10.1177/2045125315612014

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…Similar to the results of this meta-analysis, investigations in other specialties, such as orthopaedics, also noted a significantly increased risk of bleeding in patients who were prescribed SSRIs. 21 This indicates that the inhibition of platelet activation and aggregation as a result of SSRIs depletion of intracellular serotonin, that has been identified in preclinical and clinical studies, 22 translates into increased post-operative bleeding and a subsequent increased requirement for blood transfusion. A recently published study in CABG patients has demonstrated that, using specific markers of reduced platelet activity, mortality at 30 days is able to be predicted.…”

Section: Discussionmentioning

confidence: 97%

“…Studies investigating SSRIs and their relationship to upper gastrointestinal (GI) bleeding, 19 orthopaedic surgery 20 and breast surgery 21 have demonstrated variable results. Studies in upper GI bleeding noted that the risk of significant bleeding in patients taking SSRIs was exacerbated by the use of low dose aspirin or other non-steroidal anti-inflammatories (NSAIDs).…”

Section: Discussionmentioning

confidence: 99%

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Do selective serotonin reuptake inhibitors increase the risk of bleeding or mortality following coronary artery bypass graft surgery? A meta-analysis of observational studies

et al. 2018

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Do selective serotonin reuptake inhibitors increase the risk of bleeding or mortality following coronary artery bypass graft surgery? A meta-analysis of observational studies

et al. 2018

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“…As recent findings suggest a quantitative relationship between a drug’s binding affinity for the serotonin transporter and the magnitude of the increase in the bleeding risk [ 20 , 21 ], all substances that inhibit (re)uptake of serotonin may theoretically be associated with an increased bleeding risk. In addition, there are findings suggesting a localisation-specific increased risk of bleeding in association with SSRIs in the context of breast biopsies [ 22 ], perioperative bleeding [ 23 , 24 ] and intracranial haemorrhage [ 21 ]. There is also major evidence suggesting that the risk of bleeding related to SSRIs seems to be particularly increased in the upper gastrointestinal tract [ 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Risk of Bleeding Associated with Antidepressant Drugs: The Competitive Impact of Antithrombotics in Quantitative Signal Detection

Zeiss

Hiemke

Schönfeldt‐Lecuona

et al. 2021

Drugs - Real World Outcomes

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Background To date, disproportionality analysis has been unable to demonstrate the increased bleeding risk associated with antidepressant drugs, especially selective serotonin reuptake inhibitors. Objective We hypothesised that a potential signal for an increased bleeding risk may be mitigated by the effects of agents other than antidepressant drugs that are strongly associated with haemorrhages, especially antithrombotics. In addition, we investigated if the use of more specific search terms of the Medical Dictionary for Regulatory Activities facilitates the detection of signals.Methods Pharmacovigilance data from the Uppsala Monitoring Centre were used to calculate substance-specific reporting odds ratios (RORs) for all types of bleeding and gastrointestinal bleeding. Reporting odds ratios were calculated with and without antithrombotic comedication. Results Regarding any type of bleeding, no signals were found in association with antidepressant drugs. Concerning upper gastrointestinal bleeding, signals were found related to citalopram (ROR: 1.56 [95% confidence interval 1.11-2.20]) and escitalopram (ROR: 1.52 [95% confidence interval 1.03-2.25]). After removal of reports related to antithrombotics, these signals could no longer be detected, but a new signal related to St. John's Wort associated with haemorrhages was found (ROR: 1.50 [95% confidence interval 1.21-1.86]). Conclusions Antithrombotics seem unlikely to have a major impact on the detection of the bleeding risk of antidepressant drugs. The different categorisation of adverse drug reactions regarding the strength of a causal relationship between a drug and an event in the database may be relevant for this negative finding.

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“…Nonetheless, this finding seems at odds with our previous research, showing an increased risk of reoperation due to postsurgical bleeding in breast cancer patients [ 11 ]. It also contrasts with the increased risk of bleeding events associated with SSRI use among patients undergoing breast biopsy [ 43 ]. Taken together, this suggests that SSRIs may correlate with bleeding, but are unlikely to induce bleeding severe enough to warrant a blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Use of prescription drugs and risk of postoperative red blood cell transfusion in breast cancer patients: a Danish population-based cohort study

et al. 2017

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BackgroundSeveral frequently used prescription drugs may affect bleeding risk. We investigated use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), selective serotonin reuptake inhibitors (SSRIs), and statins and risk of postoperative red blood cell transfusion in breast cancer patients.MethodsUsing Danish population-based registries, we identified a cohort of women who underwent surgery for primary breast cancer (n = 22,238) during 2005–2012 and ascertained their use of aspirin, NSAIDs, SSRIs, and statins. For each drug, patients were categorized as users if they filled ≥1 prescription in the 60 days prior to surgery. We calculated the 14-day risk of red blood cell transfusion and relative risks (RRs) with 95% confidence intervals (CIs), comparing users with nonusers for each drug and adjusting for age, cancer stage, and Charlson Comorbidity Index score.ResultsIn our cohort, 1385 (6.2%) women were aspirin users, 1794 (8.0%) were NSAID users, 1110 (4.9%) were SSRI users, and 2053 (9.1%) were statin users. The overall risk of red blood cell transfusion was 1.3%. The 14-day risk of RBC transfusion was 3.5% among aspirin users versus 1.1% among aspirin nonusers (adjusted RR = 1.9, 95% CI: 1.4–2.7), and 1.8% among SSRI users versus 1.2% among SSRI nonusers (adjusted RR = 1.2, 95% CI: 0.7–1.9). Red blood cell transfusion risk was increased among NSAID users, but not in a sensitivity analysis with a 30-day exposure window. Red blood cell transfusion risk was not increased among SSRI and statin users.ConclusionsPrimary breast cancer surgery confers a low risk of RBC transfusion. Still, use of aspirin and possibly NSAIDs, but not SSRIs and statins, is associated with increased red blood cell transfusion. This increased risk is not explained by differences in age, stage, or comorbidity level.Electronic supplementary materialThe online version of this article (doi:10.1186/s13058-017-0926-2) contains supplementary material, which is available to authorized users.

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Serotonergic antidepressants and increased bleeding risk in patients undergoing breast biopsy

Abstract: This is the first study demonstrating increased bleeding events in breast biopsy patients using SAds. Clinicians should be aware that SAds may be associated with peri-operative bleeding risk, even in relatively minor procedures such as breast biopsies.

Cited by 5 publications

References 32 publications

Do selective serotonin reuptake inhibitors increase the risk of bleeding or mortality following coronary artery bypass graft surgery? A meta-analysis of observational studies

Do selective serotonin reuptake inhibitors increase the risk of bleeding or mortality following coronary artery bypass graft surgery? A meta-analysis of observational studies

Risk of Bleeding Associated with Antidepressant Drugs: The Competitive Impact of Antithrombotics in Quantitative Signal Detection

Use of prescription drugs and risk of postoperative red blood cell transfusion in breast cancer patients: a Danish population-based cohort study

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