title: Serotonergic antidepressants and increased bleeding risk in patients undergoing breast biopsy.
abstract: OBJECTIVE
  Recent investigations have shown that serotonergic antidepressant (SAd) use may increase the risk of peri-operative bleeding events. Our objective was to evaluate the possibility of a similar association in patients undergoing radiologic breast biopsies.
  
  
  METHODS
  We used data from 3890 patients undergoing 6300 biopsy procedures between January 2011 and October 2014 in the Breast Clinic of McGill University Health Centre, Montreal, Canada. In this case-control study, cases were patients reported to have abnormal bleeding during their biopsy by board-certified radiologists. A control group of nonbleeders was selected using matching according to age and type of biopsy. The correlation between abnormal bleeding and SAd use was assessed using bivariate and multivariate statistical analyses.
  
  
  RESULTS
  There were 97 patients with abnormal bleeding and 137 matched controls; 10 bleeders (cases) were on SAds (7 citalopram, 3 paroxetine) while only 1 nonbleeder (control group) was on a SAd (low-dose sertraline, 25 mg/day). SAds were significantly associated with increased bleeding risk (10.3% versus 0.7%, Fisher's Exact p = 0.001). Moreover, after adjusting for confounding factors (age, type of biopsy, size of biopsy, needle caliber, pathology result and nonsteroidal anti-inflammatory drug use, multivariate logistic regression confirmed that SAds were associated with elevated bleeding risk (16.2, 95% confidence interval 1.87-140.1, p = 0.01).
  
  
  CONCLUSIONS
  This is the first study demonstrating increased bleeding events in breast biopsy patients using SAds. Clinicians should be aware that SAds may be associated with peri-operative bleeding risk, even in relatively minor procedures such as breast biopsies.
authors.affiliation: Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, QC, Canada Cedars Breast Clinic, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Artin A
authors.initials: AA
authors.lastname: Mahdanian
authors.affiliation: Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Looper
authors.affiliation: Montreal Behavioral Medicine Centre, Hopital du Sacré-Cœur, Montreal, QC, Canada.
authors.forename: Simon L
authors.initials: SL
authors.lastname: Bacon
authors.affiliation: Cedars Breast Clinic, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Benoit
authors.initials: B
authors.lastname: Mesurolle
authors.affiliation: Cedars Breast Clinic, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Sarkis H
authors.initials: SH
authors.lastname: Meterissian
authors.affiliation: Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, QC, Canada, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Baycrest Avenue, Room FG-08, M4N 3M5, Canada.
authors.forename: Soham
authors.initials: S
authors.lastname: Rej
keywords: bleeding; breast biopsy; serotonergic antidepressants
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