Selective Serotonin Reuptake Inhibitors and Operative Bleeding Risk: A Review of the Literature.
OBJECTIVE
This study aimed to review the data on the effect of selective serotonin reuptake inhibitors (SSRIs) on bleeding during or after operative procedures and to offer guidelines for clinical management.


METHODS
Search of PubMed and MEDLINE for all articles in English from 1990-2016 with key words depression, antidepressants, bleeding, platelets, and operation.


METHODS
Studies were included if they reported information on bleeding complications during operative or childbirth procedures in patients taking antidepressants.


METHODS
Because of the limited number and heterogeneity of studies with respect to the range of operative procedures and definition of bleeding complications, a qualitative approach was taken to summarize results rather than abstracting and aggregating data.


RESULTS
The weight of the evidence is that SSRI use increases the risk of bleeding complications during and immediately after surgery. However, given the limited data, we cannot estimate the risk for a given patient having a given procedure.


CONCLUSIONS
Clinicians must consider the risk-to-benefit ratio of discontinuing an SSRI before an elective operative procedure. Discontinuing SSRI medications may result in discontinuation syndrome, symptom recrudescence, or relapse of depression, whereas continuing an SSRI during surgery exposes patients to significant bleeding risks. Antidepressant prescribers must be cognizant of and take responsibility for discussing this potential problem and considering different options. This issue must also be the responsibility of the doctor performing the procedure, but, frequently, it will be the prescribing physician who alerts the surgeon to the potential bleeding risk associated with SSRIs.
From the Columbia University College of Physicians and Surgeons, New York, and the New York State Psychiatric Institute, New York, NY.
Steven P
SP
Roose
Bret R
BR
Rutherford
D016063:Blood Loss, Surgical; D001792:Blood Platelets / Q000187:drug effects; D003863:Depression / Q000188:drug therapy; D006801:Humans; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control
D017367:Selective Serotonin Reuptake Inhibitors
Blood Coagul Fibrinolysis. 1997 Nov;8(8):517-23
9491270
Arch Facial Plast Surg. 2012 Jul-Aug;14(4):248-52
22801798
Clin Cardiol. 2010 Jun;33(6):E94-8
20552618
Basic Clin Pharmacol Toxicol. 2014 Sep;115(3):277-81
24548749
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Oct;108(4):e1-2
19778730
Blood. 1977 Dec;50(6):1137-44
922161
J Clin Psychopharmacol. 2008 Apr;28(2):230-4
18344737
Am J Psychiatry. 2014 Jan;171(1):54-61
24030313
Am Fam Physician. 2006 Aug 1;74(3):449-56
16913164
Thromb Haemost. 2004 Jan;91(1):119-28
14691577
J Affect Disord. 2012 Jan;136(1-2):99-103
21893349
Arch Womens Ment Health. 2010 Oct;13(5):453-4
20574748
Br J Clin Pharmacol. 2001 Aug;52(2):179-84
11488775
J Clin Pharmacol. 2006 Apr;46(4):468-75
16554456
J Clin Psychopharmacol. 2013 Dec;33(6):790-8
24091859
Cell Mol Life Sci. 2005 Jan;62(2):159-70
15666087
BMC Surg. 2010 Jan 24;10:3
20096133
Heart Lung Circ. 2012 Apr;21(4):206-14
22285303
J Psychosom Res. 1986;30(4):451-9
3761229
J Clin Psychopharmacol. 2000 Apr;20(2):137-40
10770450
Thromb Res. 2010 Dec;126(6):517-23
20961601
Arch Intern Med. 2003 Oct 27;163(19):2354-8
14581256
Am J Cardiol. 2002 Feb 1;89(3):331-3
11809437
JAMA. 2003 Jun 18;289(23):3106-16
12813116
Anesthesiology. 2010 Mar;112(3):631-6
20179499
Int J Surg Case Rep. 2014;5(3):129-30
24548990
Front Pharmacol. 2013 Apr 16;4:45
23596418
JAMA Intern Med. 2013 Jun 24;173(12):1075-81
23699725
Am J Psychiatry. 2000 Jun;157(6):1006-8
10831484
BMJ. 2013 Aug 21;347:f4877
23965506
Proc Natl Acad Sci U S A. 1998 Jul 7;95(14):8070-4
9653141
Clin Haematol. 1977 Oct;6(3):671-93
912957
Neurology. 2012 Oct 30;79(18):1862-5
23077009
Am J Cardiovasc Drugs. 2006;6(4):243-50
16913825
Thromb Diath Haemorrh. 1971;25(1):53-80
5577974
JAMA. 2002 Aug 14;288(6):701-9
12169073
J Postgrad Med. 2007 Jan-Mar;53(1):44-5
17244971
Arch Gen Psychiatry. 2008 Jul;65(7):795-803
18606952
J Thromb Haemost. 2007 Oct;5(10):2149-51
17883707
Eur Spine J. 2012 Oct;21(10):2070-8
22290783
PLoS One. 2014 May 21;9(5):e95906
24848000
Arch Intern Med. 1998 Jul 13;158(13):1422-6
9665350
Circulation. 2002 Mar 5;105(9):1049-53
11877353
Arch Gen Psychiatry. 2000 Sep;57(9):875-82
10986551
Gastrointest Endosc. 2011 Jul;74(1):22-34.e1
21704806
Clin Pharmacol Ther. 2000 Oct;68(4):435-42
11061584
Am J Cardiol. 2009 May 15;103(10):1391-5
19427434
Thromb Haemost. 2009 Sep;102(3):511-9
19718472
Int J Neuropsychopharmacol. 2000 Sep;3(3):229-235
11343600
Pharmacol Res. 2001 May;43(5):453-62
11394937
Clin Gastroenterol Hepatol. 2009 Dec;7(12):1314-21
19716436
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Oct;112(4):463-7
21821439
Aesthetic Plast Surg. 2013 Jun;37(3):561-6
23571783
Gen Hosp Psychiatry. 2010 Jul-Aug;32(4):e9-e10
20633737
Psychosomatics. 2012 Nov-Dec;53(6):559-65
23157994
Neuropsychopharmacology. 2007 Nov;32(11):2369-74
17356575