Serotonergic antidepressants and perioperative bleeding risk: a systematic review

Abstract

Introduction: Serotonergic antidepressants (SAds) are known to increase bleeding events, with a number of recent studies investigating this risk in surgical settings. Our main objective was to synthesize the current evidence to evaluate the clinical importance of SAd-related bleeding risk in the perioperative period.

Methods: A systematic review of MEDLINE, Embase and PsychINFO until November 2013 was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We examined the risk of perioperative bleeding adverse events in SAd users in comparison to controls.

Results: A total of 13 relevant studies were identified across a broad variety of surgical procedures. SAds were associated with an increased risk of perioperative bleeding (odds ratios [ORs] = 1.21 – 4.14) and blood transfusions (ORs = 0.93 – 3.71).

Conclusions: SAds are associated with increased perioperative bleeding events, particularly abnormal bleeding and blood transfusions. From a clinical perspective, the potential bleeding risks of SAds in surgical settings need to be carefully weighed against their psychiatric benefits. Future research will need to investigate potential strategies to mitigate SAd-related bleeding risk in the surgical context.

Keywords::

• antidepressants
• blood transfusion
• perioperative bleeding
• selective serotonin reuptake inhibitors
• serotonergic antidepressants
• surgery

Acknowledgments

This review was done as a joint project in Psychiatry Department of Jewish General Hospital (JGH), the Montreal Behavioural Medicine Centre at Hôpital du Sacré-Cœur and Cedars Clinic of McGill University Health Centre (MUHC). The authors are, therefore, grateful to all personnel and staff of these centers, especially to Tara Landry at MUHC library, Julia Kleinberg at JGH library, Kim Martire and Anita Svadzian at MUHC.

Notes

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