Use of Serotonergic Antidepressants and Bleeding Risk in Orthopedic Patients

Haelst, Ingrid M. M. van; Egberts, Toine C. G.; Doodeman, Hiëronymus J.; Traast, Han S.; Burger, Bart J.; Kalkman, Cor J.; Klei, Wilton A. van

doi:10.1097/aln.0b013e3181cf8fdf

Cited by 71 publications

(59 citation statements)

References 29 publications

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“…Those with lower or no serotonin affinity include most importantly bupropion, as well as doxepin, nortriptyline, etc. [3].…”

Section: Introductionmentioning

confidence: 99%

“…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%

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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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“…Those with lower or no serotonin affinity include most importantly bupropion, as well as doxepin, nortriptyline, etc. [3].…”

Section: Introductionmentioning

confidence: 99%

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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“…The study population consisted of patients who underwent a variety of orthopedic surgeries. In the study by van Haelst et al [14] . The study population consisted of patients who underwent total hip arthroplasty, and the outcome measures were estimated blood loss and blood transfusion requirement.…”

Section: Discussionmentioning

confidence: 99%

“…This pharmacological mechanism of anti-platelet properties of serotonergic drugs is postulated to affect primary hemostasis, potentiating hemorrhagic events. The inhibition of platelet aggregation caused by the serotonergics suggests that these drugs may increase the risk of perioperative and post-surgical bleeding [13,14] . 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.…”

Section: Introductionmentioning

confidence: 99%

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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“…59,60 (Irreversible inhibitors such as tranylcypromine may not be suited due to the necessity of low tyramine diet.) Reboxetine, in particular, although possibly effective in post-myocardial infarction depression and which has low interaction potential, is no longer considered a firstchoice drug.…”

Section: General Aspects Of Psychiatric Pharmacotherapy In Patients Wmentioning

confidence: 99%

Psychocardiology: the spectrum of stress in the genesis of heart disease: a point of view

Koch¹

2013

RRCC

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Psychiatric disease, particularly depression and stress disorders, worsens the outcome of cardiovascular disease by about a factor of two to three. Conversely, heart disease can also cause or aggravate affective disorders in the person concerned. Although this mind-heart interaction has been known since the 1930s, many questions about the underlying mutual pathophysiology remain. Apart from psychological stress models, inflammatory or psychoimmunology processes and metabolic or endocrinological mechanisms may be involved, as might lifestyle and drug treatments. Takotsubo, or broken-heart cardiomyopathy, which frequently occurs in response to stressful events, and post-myocardial infarction depression may serve as paradigms in seeking to understand the pathological basis of the mind-heart relationship.

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Use of Serotonergic Antidepressants and Bleeding Risk in Orthopedic Patients

Abstract: Patients undergoing total hip arthroplasty who continue the use of serotonergic antidepressants show a significantly higher, but clinically unimportant, intraoperative blood loss, without an increase in perioperative transfusion requirements.

Cited by 71 publications

References 29 publications

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

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

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

Psychocardiology: the spectrum of stress in the genesis of heart disease: a point of view

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