Abstract
BackgroundSelective serotonin reuptake inhibitors (SSRI) decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association.MethodsWe conducted a population-based study of the risk of re-operation due to post-surgical bleeding within two weeks of primary surgery among Danish women with primary breast cancer. Patients were categorised according to their use of SSRI: never users, current users (SSRI prescription within 30 days of initial breast cancer surgery), and former users (SSRI prescription more than 30 days before initial breast cancer surgery). We calculated the risk of re-operation due to post-surgical bleeding within 14 days of initial surgery, and the relative risk (RR) of re-operation comparing SSRI users with never users of SSRI adjusting for potential confounders.Results389 of 14,464 women (2.7%) were re-operated. 1592 (11%) had a history of SSRI use. Risk of re-operation was 2.6% among never users, 7.0% among current SSRI users, and 2.7% among former users. Current users thus had an increased risk of re-operation due to post-operative bleeding (adjusted relative risk = 2.3; 95% confidence interval (CI) = 1.4, 3.9) compared with never users. There was no increased risk of re-operation associated with former use of SSRI (RR = 0.93, 95% CI = 0.66, 1.3).ConclusionsCurrent use of SSRI is associated with an increased risk of re-operation due to bleeding after surgery for breast cancer.
Highlights
Selective serotonin reuptake inhibitors (SSRI) decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding
Data on potential confounders To account for factors that may be associated with SSRI anti-depressant prescription and post-surgical bleeding, we obtained data on age at breast cancer surgery and on preoperative use of platelet inhibitors, vitamin K antagonists, oral anti-coagulants, non-steroidal anti-inflammatory drugs (NSAID) non-SSRI anti-depressants (tri-cyclic anti-depressants (TCA), tetracyclical anti-depressants (TeCA), and other anti-depressants)
Given that reoperation for post-surgical bleeding was rare in all combinations of the independent variables, these adjusted odds ratios provide an estimate of the adjusted risk ratios
Summary
Selective serotonin reuptake inhibitors (SSRI) decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Selective Serotonin Reuptake Inhibitors (SSRI) decrease platelet serotonin storage and platelet-function in humans [1,2] and are associated with upper gastrointestinal bleeding [3,4]. This mechanism suggests that SSRI use may increase the risk of post-surgical bleeding, but data on peri-operative risk of bleeding associated with use of SSRI are few and contradicting [5,6]. An increased risk of post-surgical bleeding associated with SSRI use among breast cancer patients may have important clinical implications
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