Use of Selective Serotonin Reuptake Inhibitors Antidepressants and Bleeding Risk in Breast Cosmetic Surgery

Basile, F; Basile, Antonio Roberto; Basile, Vinicius Volpe

doi:10.1007/s00266-013-0111-7

Cited by 32 publications

(17 citation statements)

References 21 publications

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“…The studies, which vary in terms of methodology and types of surgery, include: seven orthopedic (36–42), four coronary artery bypass grafting (CABG) (43–46), one breast cancer (47), one breast cosmetic (48), one facelift (49), two postpartum (50,51), one dental, (52) one percutaneous endoscopic biopsy (53), and one large study of all in-hospital operative procedures (3). …”

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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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%

Selective Serotonin Reuptake Inhibitors and Operative Bleeding Risk

Roose

Rutherford

2016

J Clin Psychopharmacol

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“…Furthermore, alcohol and other pharmacological agents may potentiate the effects of both ASA and non-ASA NSAIDs. [161][162][163][164][165][166][167][168][169][170] Summary Recommendations for Non-ASA NSAIDs…”

Section: Procedural Recommendations: Overviewmentioning

confidence: 99%

“…Patients using SSRIs had a 4-fold greater risk of breast hematoma formation requiring intervention compared with nonusers. 167 Serotonin reuptake inhibitor use was also associated with increased perioperative bleeding in orthopedic surgery. 170,386 In a retrospective follow-up study of 520 patients undergoing orthopedic surgery, the risk of intraoperative blood transfusion almost quadrupled in the SRI group compared with nonusers.…”

Section: Mechanisms Of Increased Bleeding Riskmentioning

confidence: 99%

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition)

Narouze

Benzon

Provenzano³

et al. 2017

Regional Anesthesia and Pain Medicine

118

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The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures. The ASRA regional anesthesia anticoagulation guidelines were largely deemed appropriate for the low- and intermediate-risk categories, but the high-risk category required further investigation. The first guidelines specific to interventional spine and pain procedures were published in 2015. Recent reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures, the development of new regional anesthesia and acute pain guidelines, and the development of new anticoagulants and antiplatelet medications necessitate complementary updated guidelines. The authors desired coordination with the authors of the recently updated regional and acute pain anticoagulation guidelines. The latest evidence was sought through extensive database search strategies and the recommendations were evidence based when available and pharmacology driven otherwise. We could not provide strength and grading of these recommendations because there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations. This publication is intended as a living document to be updated periodically with consideration of new evidence.

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“…Furthermore, alcohol and other pharmacological agents may potentiate the effects of both aspirin and non-aspirin NSAIDs. [145][146][147][148][149][150][151][152][153][154] For individuals taking aspirin for secondary prophylaxis who will be discontinuing aspirin while undergoing a spinal cord stimulator trial, it is recommended that the length of the trial be minimized. It is suggested that, for these patients, one considers a risk-benefit ratio for adequate trialing versus the possibility of cardiovascular sequelae.…”

Section: Procedural Recommendationsmentioning

confidence: 99%

“…Patients using SSRIs had a 4-fold greater risk of breast hematoma formation requiring intervention compared with nonusers. 151 The SRI use was also associated with increased perioperative bleeding in orthopedic surgery. 154,350 In a retrospective follow-up study of 520 patients undergoing orthopedic surgery, the risk of intraoperative blood transfusion almost quadrupled in the SRI group compared with nonusers [adjusted odds ratio (OR), 3.7; 95% CI, 1.4-10.2].…”

Section: Mechanisms Of Increased Bleeding Riskmentioning

confidence: 99%

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

Narouze

Benzon

Provenzano³

et al. 2015

Regional Anesthesia and Pain Medicine

267

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Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures. In response, ASRA formed a guidelines committee. After preliminary review of published complication reports and studies, committee members stratified interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. The ASRA guidelines were deemed largely appropriate for the low- and intermediate-risk categories, but it was agreed that the high-risk targets required an intensive look at issues specific to patient safety and optimal outcomes in pain medicine. The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.

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Use of Selective Serotonin Reuptake Inhibitors Antidepressants and Bleeding Risk in Breast Cosmetic Surgery

Abstract: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cited by 32 publications

References 21 publications

Selective Serotonin Reuptake Inhibitors and Operative Bleeding Risk

Selective Serotonin Reuptake Inhibitors and Operative Bleeding Risk

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition)

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

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