title: Psychopharmacologic treatment and blood transfusion in fast-track total hip and knee arthroplasty.
abstract: Selective serotonin reuptake inhibitors (SSRIs) and other psychotropics are receiving increasing attention due to reports on inhibition of thrombocyte function and an increased bleeding risk in surgical settings. Studies in total hip and total knee arthroplasty (THA and TKA, respectively) have shown conflicting results, questioning whether the potential increased bleeding risk is of clinical importance.
  
  
  
  Prospective consecutive collection of data on preoperative comorbidity in patients undergoing primary unilateral THA or TKA was cross-referenced with regional transfusion databases and The Danish National Database of Reimbursed Prescriptions for information regarding blood transfusions and psychopharmacologic treatment. All participating orthopedic centers followed similar perioperative guidelines. Multiple logistic regression analysis was applied to calculate odds ratios (ORs) for transfusion between preoperative users and nonusers of psychotropics.
  
  
  
  Of 8402 patients, 569 (6.8%) were SSRI users versus 7833 (93.2%) nonusers. A total of 109 (19,2%) patients in the SSRI group and 700 (8.9%) in the "no-SSRI" group received blood intra- or postoperatively. Preoperative SSRI treatment was a risk factor for perioperative transfusion (OR, 1.98; 95% confidence interval [CI], 1.44-2.70). Other antidepressants (OAs) were associated with an increased risk of transfusion (OR, 1.69; 95% CI, 1.17-2.44) as well as the combination of SSRIs and OAs (OR, 3.31; 95% CI, 1.79-6.13). Singular use of antipsychotics (APs) increased the transfusion risk (OR, 2.37; 95% CI, 1.04-2.41), while AP medicine in combination with antidepressants did not.
  
  
  
  Preoperative treatment with SSRIs, OAs, or APs are independent risk factors for blood transfusion in elective fast-track THA and TKA.
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark.|Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Aarhus, Denmark.
authors.forename: Silas Hinsch
authors.initials: SH
authors.lastname: Gylvin
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark.|Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Aarhus, Denmark.
authors.forename: Christoffer Calov
authors.initials: CC
authors.lastname: Jørgensen
authors.affiliation: Psychiatric Centre Copenhagen and Laboratory of Neuropsychiatry, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Fink-Jensen
authors.affiliation: Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark.|Department of Surgery, University of Texas Health Medical School, Houston, Texas.|Capital Region Blood Bank, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Pär I
authors.initials: PI
authors.lastname: Johansson
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark.|Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Aarhus, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001792:Blood Platelets; D001803:Blood Transfusion; D016208:Databases, Factual; D003718:Denmark; D006470:Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007430:Intraoperative Care; D011182:Postoperative Care; D011446:Prospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors