Movig Kris L L, Janssen Michiel W H E, de Waal Malefijt Jan, Kabel Peter J, Leufkens Hubert G M, Egberts Antoine C G
Hospital Pharmacy Midden-Brabant, St Elisabeth Hospital and TweeSteden Hospital, Tilburg, The Netherlands.
Arch Intern Med. 2003 Oct 27;163(19):2354-8. doi: 10.1001/archinte.163.19.2354.
Several reports of various bleeding problems associated with the use of serotonergic antidepressants have been published. However, no information concerning the effect of these drugs on perioperative blood loss and blood transfusion requirements during orthopedic surgery is available. The objective of this study was to determine the association between use of serotonergic antidepressants and perioperative blood loss and transfusion in orthopedic surgical patients.
A retrospective follow-up study, using routinely collected hospital and pharmacy data, was conducted among all orthopedic patients undergoing surgery from January 1, 1999, through December 31, 2000. The actual blood transfusion requirements and blood loss during surgery were assessed. Patients were divided into 3 groups for comparison: users of serotonergic antidepressants, users of nonserotonergic antidepressants, and nonusers of antidepressants. The Medical Ethics Committee approved the study protocol, and informed consent was obtained from all patients or their legal relatives.
A total of 520 subjects with evaluable data participated in the study. The risk of blood transfusion almost quadrupled for the serotonergic antidepressant group as compared with the nonusers (adjusted odds ratio, 3.71; 95% confidence interval, 1.35-10.18). Patients using nonserotonergic antidepressants had no increased risk (odds ratio, 0.74; 95% confidence interval, 0.10-5.95).
Use of serotonergic antidepressants is associated with an increased risk of bleeding and subsequent need for blood transfusion during orthopedic surgery. The bleeding could be attributed to inhibition of serotonin-mediated platelet activation.
已有多篇关于使用血清素能抗抑郁药引发各种出血问题的报道。然而，尚无关于这些药物对骨科手术围手术期失血及输血需求影响的相关信息。本研究的目的是确定血清素能抗抑郁药的使用与骨科手术患者围手术期失血及输血之间的关联。
采用回顾性随访研究，利用常规收集的医院和药房数据，对1999年1月1日至2000年12月31日期间接受手术的所有骨科患者进行研究。评估手术期间的实际输血需求和失血量。患者分为3组进行比较：血清素能抗抑郁药使用者、非血清素能抗抑郁药使用者和未使用抗抑郁药者。医学伦理委员会批准了研究方案，并获得了所有患者或其法定亲属的知情同意。
共有520名具有可评估数据的受试者参与了研究。与未使用者相比，血清素能抗抑郁药组的输血风险几乎增加了两倍（调整后的优势比为3.71；95%置信区间为1.35 - 10.18）。使用非血清素能抗抑郁药的患者风险未增加（优势比为0.74；95%置信区间为0.10 - 5.95）。
在骨科手术中，使用血清素能抗抑郁药会增加出血风险及随后的输血需求。出血可能归因于血清素介导的血小板活化受到抑制。
