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Learning Objective 1: 1.The learner will be able to describe the effect of serotonergic antidepressants on platelet function, and their association with abnormal bleeding tendencies.
Learning Objective 2: 2.The learner will have an enhanced knowledge about the association of selective serotonin reuptake inhibitors and their effect on bleeding risk.
Background: Serotonergic antidepressants are one of the most extensively prescribed classes of drugs used for the treatment of depression, obsessive-compulsive disorder, anxiety disorders and a variety of other psychiatric disorders. Although these drugs have been known to exhibit a favorable safety profile, numerous studies have reported an association between serotonergic antidepressant uses and increased bleeding. However, data on effect of serotonergic antidepressants on perioperative bleeding risk is limited and conflicting, and its clinical relevance to perioperative care is uncertain.
Objective: This study aimed to determine the association between the preoperative use of serotonergic antidepressants and excessive bleeding during total knee arthroplasty.
Methodology: A retrospective analysis was conducted of 80 patients who underwent elective primary total knee arthroplasty in a large Veterans Affairs hospital. The index group included 40 patients who used serotonergic antidepressants in the preceding 4 weeks prior to surgery, and the reference group included 40 patients who were nonusers. The primary outcome was the change in hematocrit; and the secondary outcomes were the amount of estimated blood loss and the requirement for blood transfusion.
Results: This study found no significant association between current preoperative use of serotonergic antidepressants and the variables of change in hematocrit, estimated blood loss and the requirement of blood transfusion.
Conclusion: This retrospective clinical inquiry of patients undergoing total knee arthroplasty who continued to use serotonergic antidepressants did not show a significantly higher perioperative blood loss. It was however noted that patients on serotonergic antidepressants had significantly lower preoperative hemoglobin and hematocrit, and in view of this association warrants further research.