Dall Michael, Primdahl Annie, Damborg Frank, Nymark Tine, Hallas Jesper
Research Unit of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark; Department of Medicine, Odense University Hospital, Svendborg, Denmark.
Basic Clin Pharmacol Toxicol. 2014 Sep;115(3):277-81. doi: 10.1111/bcpt.12218. Epub 2014 Mar 14.
In vitro studies have shown that selective serotonin reuptake inhibitors inhibit platelet aggregation. It is well documented that SSRIs cause serious gastrointestinal bleeding, but studies on other bleeding manifestations have been equivocal. Our objective was to determine a possible association between use of serotonergic antidepressants (SA) and perioperative bleeding during hip replacements. We conducted a retrospective study between 1 January 2007 and 30 June 2012 among patients that underwent a primary unilateral uncemented total hip arthroplasty (THA). Information was collected on the observed blood loss and the need for blood transfusions among this group. We compared the blood loss between users of SA, users of non-serotonergic antidepressants (NSA) and non-users, while adjusting for potential confounders using multivariate linear regression. We indentified 1318 patients that underwent a THA in the study period. The average volume of surgical bleeding was 350 ml. The adjusted incremental blood loss associated with use of SA and NSA was 93, 95% confidence interval (38-147) ml and -50 (-125 to 25) ml compared with non-use. Only 48 subjects (3.6%) had transfusions. Use of SA was associated with an increased blood loss compared with non-users. The hypothesis that SA impairs haemostasis is supported by these results.
体外研究表明，选择性5-羟色胺再摄取抑制剂可抑制血小板聚集。有充分文献记载，选择性5-羟色胺再摄取抑制剂会导致严重的胃肠道出血，但针对其他出血表现的研究结果并不明确。我们的目的是确定使用血清素能抗抑郁药（SA）与髋关节置换术围手术期出血之间可能存在的关联。我们在2007年1月1日至2012年6月30日期间，对接受初次单侧非骨水泥型全髋关节置换术（THA）的患者进行了一项回顾性研究。收集了该组患者观察到的失血量和输血需求信息。我们比较了使用SA的患者、使用非血清素能抗抑郁药（NSA）的患者和未使用抗抑郁药的患者之间的失血量，同时使用多变量线性回归对潜在混杂因素进行了调整。我们确定在研究期间有1318名患者接受了THA。手术平均失血量为350毫升。与未使用相比，使用SA和NSA的调整后增量失血量分别为93毫升（95%置信区间为38 - 147毫升）和 -50毫升（-125至25毫升）。只有48名受试者（3.6%）接受了输血。与未使用者相比，使用SA与失血量增加有关。这些结果支持了SA会损害止血功能的假设。
