Abstract
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.
Highlights
Several frequently used prescription drugs may affect bleeding risk
45% were aged below 60 years at diagnosis, 85% had a Charlson Comorbidity Index (CCI) score of 0, and about 70% underwent Breast-conserving surgery (BCS) as primary breast cancer surgery
Primary breast cancer surgery confers a low risk of red blood cell (RBC) transfusion
Summary
Several 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. Prescription medicines that affect platelet function may increase the risk of postsurgical bleeding, necessitating transfusion. Selective serotonin reuptake inhibitors (SSRIs) decrease platelet serotonin storage and platelet function and are correlated with increased risk of both gastrointestinal and postsurgical bleeding [9,10,11,12]. Other frequently used drugs, such as statins, may increase the Thomsen et al Breast Cancer Research (2017) 19:135 risk of bleeding through a potential direct antiplatelet effect and an antithrombotic effect unrelated to cholesterol-lowering activity [13, 14]
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