Abstract
BackgroundRecent studies have shown that an increased bleeding tendency can be caused by Selective Serotonin Reuptake Inhibitors (SSRI) use. We aimed to investigate the occurrence and risk of blood transfusion in SSRI users compared to non-SSRI users in a cohort of patients admitted for hip-surgery.MethodsWe conducted a retrospective cohort study of patients who underwent planned or emergency hip surgery from 1996 to 2011 in the Academic Medical Center in Amsterdam. Primary outcome measure was risk of blood transfusion. Secondary outcome measures were pre- and postoperative hemoglobin level. Multivariate logistic regression was used to adjust for potential confounders.ResultsOne-hundred and fourteen SSRI users were compared to 1773 non-SSRI users. Risk of blood transfusion during admission was increased for SSRI users in multivariate analyses (OR 1.7 [95% CI 1.1–2.5]). Also, pre-operative hemoglobin levels were lower in SSRI users (7.8±1.0 mmol/L) compared to non-SSRI users (8.0±1.0 mmol/L) (p = 0.042)), as were postoperative hemoglobin levels (6.2±1.0 mmol/L vs. 6.4±1.0 mmol/L respectively) (p = 0.017)).ConclusionsSSRI users undergoing hip surgery have an increased risk for blood transfusion during admission, potentially explained by a lower hemoglobin level before surgery. SSRI use should be considered as a potential risk indicator for increased blood loss in patients admitted for hip surgery. These results need to be confirmed in a prospective study.
Highlights
Peri-operative blood transfusions increase the relative risk of postoperative infections and are associated with considerable morbidity and mortality [1,2]
As hip surgery is known to be the leading indication for blood transfusion in orthopedic patients [15], we aimed to study whether Selective Serotonin Reuptake Inhibitors (SSRI) increase risk of blood transfusion during admission in a cohort of patients undergoing hip surgery
SSRI users had more comorbidity, more often underwent emergency hip surgery and more often lived in institutions compared to non-SSRI users
Summary
Peri-operative blood transfusions increase the relative risk of postoperative infections and are associated with considerable morbidity and mortality [1,2]. The amount of peri-operative blood loss can be negatively influenced by the use of drugs that increase bleeding tendency, such as anti-thrombotic drugs [4]. Increased bleeding tendency is associated with the use of Selective Serotonin Reuptake Inhibitors (SSRIs) [5,6,7,8]. In a recent large cohort study, peri-operative use of SSRIs was even directly associated with a higher risk of adverse events, such as in-hospital mortality and hospital readmission within 30 days [9]. Recent studies have shown that an increased bleeding tendency can be caused by Selective Serotonin Reuptake Inhibitors (SSRI) use. We aimed to investigate the occurrence and risk of blood transfusion in SSRI users compared to non-SSRI users in a cohort of patients admitted for hip-surgery
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