Increased Risk of Blood Transfusion with Serotonergic Antidepressant Use in Older Patients Undergoing Orthopaedic Surgery


Arch Intern Med 2003 Oct 27;163:19:2354-8. "Relationship of serotonergic antidepressants and need for blood transfusion in orthopedic surgical patients"

11/12/2003 11:52:00 AM
By Deanna M Green, PhD


Serotonergic antidepressant use is associated with increased perioperative blood loss and a greater requirement for blood transfusion in patients undergoing orthopaedic surgery, according to a recent Dutch study. Selective serotonin reuptake inhibitors are frequently prescribed to treat psychiatric diseases and have become one of the most widely prescribed classes of drugs. However, recent reports have suggested an increased incidence of bleeding disorders in patients taking serotonergic antidepressants. Whether antidepressant use has an effect on blood loss during orthopaedic surgery has yet to be investigated. Kris L. Movig, PhD, and colleagues at the St. Elisabeth Hospital and TweeSteden Hospital, Tilburg, the Netherlands, conducted a retrospective study to evaluate the association between serotonergic antidepressant use and perioperative blood loss in patients who underwent orthopaedic surgery. The study included data on 520 patients (366 women, average age 68) receiving hip, knee, or spine implants. Patients were categorised according to antidepressant use and risk of perioperative blood transfusion was then assessed in relation to antidepressant use. Overall, 59 patients required perioperative blood transfusion and 26 were taking serotonergic antidepressants (paroxetine, fluoxetine, clomipramine, venlafaxine, fluvoxamine, and sertraline). Furthermore, 6 patients taking serotonergic antidepressants had required a perioperative blood transfusion. Serotonergic antidepressant use was significantly associated with greater blood loss during surgery. Specifically, antidepressant users lost on average 1,019 mL, while nonusers averaged 582 mL ([P = .001). Moreover, these patients also had a significantly higher risk of blood transfusion compared to nonusers (adjusted odds ratio, 3.71). Use of non-steroidal anti-inflammatory drugs, methotrexate, or iron supplements also increased the risk of blood transfusion. Notably, patients taking nonserotonergic antidepressants did not have an increased risk of blood transfusion (odds ratio, 0.74). In addition, vitamin K antagonists, calcium channel blockers, and corticosteroid treatment were not associated with an increased risk. The authors conclude that "patients using serotonergic agents lost significantly more blood during orthopaedic surgery than those not using any antidepressant." They also warn that this "could pose a potential health problem for elderly patients because of the widespread and increasing use of antidepressants." However, they note that while clinically important, "it remains an uncommon adverse effect that should carefully be examined along with other information."

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