title: Selective serotonin reuptake inhibitors, venlafaxine and duloxetine are associated with in hospital morbidity but not bleeding or late mortality after coronary artery bypass graft surgery.
abstract: BACKGROUND
  No Australian study has reported the association between selective-serotonin reuptake inhibitor (SSRI) and serotonin noradrenaline reuptake inhibitor (SNRI) with coronary artery bypass graft (CABG) surgery morbidity and mortality.
  
  
  METHODS
  4136 patients underwent CABG surgery between January 1996 and December 2008 and 105 (2.5%) were SSRI/SNRI users. Bleeding events included platelet, fresh frozen plasma and packed red blood cell transfusion, reoperation for bleeding and gastrointestinal bleeding. In-hospital morbidity included renal failure, stroke, ventilation >24h, deep sternal wound infection, reoperation (any cause), myocardial infarction and mortality.
  
  
  RESULTS
  Median follow-up was 4.7 years (interquartile range, 2.3-7.9 years) and there were 727 deaths (17.6% of total). Use of SSRI/SNRI was associated with new requirement for renal dialysis (adjusted OR = 2.18; 95% CI, 1.06-4.45, p = .03) and ventilation >24h (adjusted OR = 1.69; 95% CI, 1.03-2.78, p = .04). Neither SSRI/SNRI use nor SSRI/SNRI and concomitant anti-platelet medication increased the odds for any bleeding events (all p>.20). No association was evident with all-cause mortality (adjusted hazard ratio = 1.60; 95% CI .59-4.35, p = .36), or cardiac mortality (adjusted hazard ratio = .31; 95% CI, .04-2.26, p = .25).
  
  
  CONCLUSIONS
  SSRI/SNRI users experienced an increased risk of renal dysfunction and prolonged ventilation, but not bleeding events or long-term mortality after CABG surgery.
authors.affiliation: Cardiac and Thoracic Surgical Unit, Department of Medicine, Flinders Medical Centre and The Flinders University, Adelaide, South Australia, Australia. Phil.Tully@health.sa.gov.au
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.forename: Tess
authors.initials: T
authors.lastname: Cardinal
authors.forename: Jayme S
authors.initials: JS
authors.lastname: Bennetts
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001026:Coronary Artery Bypass / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery; D003511:Cyclohexanols / Q000009:adverse effects* / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy; D000068736:Duloxetine Hydrochloride; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012121:Respiration, Artificial; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013876:Thiophenes / Q000009:adverse effects* / Q000627:therapeutic use; D013997:Time Factors; D000069470:Venlafaxine Hydrochloride
chemical_list: D003511:Cyclohexanols; D000068736:Duloxetine Hydrochloride; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes; D000069470:Venlafaxine Hydrochloride