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Use of serotonin reuptake inhibitors is not associated with increased bleeding after CABG

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Abstract

Objectives

Selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs) are the most commonly prescribed antidepressants worldwide. Studies suggest that SSRI/SNRIs can increase bleeding following different surgical procedures, including open heart surgery, but results are conflicting. The objective of this study was to analyse their effects on bleeding after coronary artery bypass grafting (CABG).

Methods

Of 1237 patients that underwent CABG in Iceland in 2007–2016, 97 (7.8%) used SSRIs/SNRIs preoperatively and were compared to a reference group (n = 1140). Bleeding was assessed using 24-h chest-tube output, number of RBC units transfused and reoperation for bleeding. Thirty-day mortality rates and incidence of complications were also compared.

Results

The two groups were comparable with respect to preoperative and operative variables, with the exception of BMI being significantly higher in the SSRI/SNRI group (30.2 vs. 28.3 kg/m2, p < 0.001). No significant differences were observed between groups in 24-h chest-tube output [815 (SSRI/SNRI) vs. 877 ml (reference), p = 0.26], number of RBC units transfused (2.2 vs. 2.2, p = 0.99) or the rate of reoperation for bleeding (4.1% vs. 6.0%, p = 0.61). The incidences of complications and 30-day mortality rate were also similar.

Conclusions

Using three different criteria, preoperative use of SSRIs/SNRIs was not shown to increase bleeding after CABG. Furthermore, short-term complications as well as 30-day mortality rates did not differ from those of controls. Thus, temporary cessation of SSRI/SNRI treatment prior to CABG to decrease the risk of bleeding is unwarranted.

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Funding

This study was funded by the Scientific Foundation of Landspitali and University of Iceland Research Foundation.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland

    Alexandra A. Heimisdottir, Simon Morelli, Hera Johannesdottir, Solveig Helgadottir & Tomas Gudbjartsson

  2. Department of Psychiatry, Landspitali University Hospital, Reykjavik, Iceland

    Engilbert Sigurðsson

  3. Department of Medicine and Health, Linköping University, Linköping, Sweden

    Eric Enger

  4. Anesthesiology and Intensive Care, Akademiska University Hospital, Uppsala, Sweden

    Solveig Helgadottir

  5. Faculty of Medicine, University of Iceland, Reykjavik, Iceland

    Alexandra A. Heimisdottir, Engilbert Sigurðsson & Tomas Gudbjartsson

Authors
  1. Alexandra A. Heimisdottir
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  2. Eric Enger
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  4. Hera Johannesdottir
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  6. Engilbert Sigurðsson
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  7. Tomas Gudbjartsson
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Correspondence to Tomas Gudbjartsson.

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Heimisdottir, A.A., Enger, E., Morelli, S. et al. Use of serotonin reuptake inhibitors is not associated with increased bleeding after CABG. Gen Thorac Cardiovasc Surg 68, 1312–1318 (2020). https://doi.org/10.1007/s11748-020-01353-y

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  • DOI: https://doi.org/10.1007/s11748-020-01353-y

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