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Study links SSRIs to perioperative bleeding risk

Friday May 17, 2013
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Selective serotonin reuptake inhibitors, among the most widely prescribed antidepressant medications, are associated with increased risk of bleeding, transfusion, hospital readmission and death when taken around the time of surgery, according to an analysis.

Researchers with the University of California, San Francisco, and Baystate Medical Center in Springfield, Mass., looked at the medical records of more than 530,000 patients who underwent surgery at 375 U.S. hospitals between 2006 and 2008.

"There have been small studies that suggested there was a problem, but it has never been well-proven," Andrew D. Auerbach, MD, MPH, a UCSF professor of medicine, said in a news release. "With this huge data set, we feel confident in saying that SSRIs are associated with a 10% increased risk for these adverse outcomes."

The authors noted that patients on SSRIs are more likely to have conditions that in themselves increase surgical risk, such as obesity, chronic pulmonary disease and depression. To address the question of whether these factors might have accounted for the differences in outcomes, they retrospectively matched patients who had taken SSRIs with patients who were not taking the drugs.

After matching and controlling for variables such as age, gender, medical condition and depression, as reported April 29 on the website of JAMA Internal Medicine (formerly the Archives of Internal Medicine), patients on SSRIs still were at increased risk.

The researchers also looked at whether the increased risk could be accounted for by patients receiving SSRIs for the first time before surgery. "This was not the case," Auerbach said. "These drugs are almost never used acutely. They are prescribed for chronic conditions such as depression, almost always for long-term use."

The study was not designed to look at possible causes for the increased risk. However, Auerbach noted, SSRIs are known to interfere with the functioning of platelets, and platelet dysfunction can lead to excess bleeding.

Auerbach cautioned that since the study was retrospective, "a prospective observational study, in which patients are randomly assigned to take SSRIs around the time of surgery, is still needed."

Although advising patients not to take SSRIs before surgery would be premature, he said, "itís definitely worth discussing with your surgeon or primary care physician."

Read the study abstract: http://archinte.jamanetwork.com/article.aspx?articleid=1682366.


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