Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
J Arthroplasty. 2019 Dec;34(12):2898-2902. doi: 10.1016/j.arth.2019.04.057. Epub 2019 Jun 22.
Selective serotonin reuptake inhibitors (SSRIs) have been shown in both orthopedic and general surgery literature to be associated with an increased risk of blood loss, and this is thought to occur via diminished platelet serotonin reuptake and subsequent decline in platelet aggregation potential. In this study, we aim at quantifying the effect of treatment with SSRIs on blood loss and transfusion rates following total hip (THA) or total knee arthroplasty (TKA).
THA (4485) and TKA (5584) cases from January 2013 to December 2017 at the investigating institution were queried and analyzed separately from an institutional database. Patients were stratified by utilization of an SSRI at the time of surgery. Patient demographics, baseline coagulopathy, preoperative and postoperative hemoglobin, transfusion, and length of stay were obtained to compare the 2 cohorts.
The transfusion rate for SSRI users was 3.9% in the TKA group and 8.5% in the THA group. After controlling for age, gender, body mass index, presence of coagulopathy, procedure (THA vs TKA), and SSRI status, SSRI utilization was significantly associated with increased blood loss (P < .004), and logistic regression controlling for the same variables showed SSRI utilization to be predictive of transfusion (odds ratio, 1.476; P < .001).
SSRI utilization was associated with increased perioperative blood loss and predictive of transfusion risk, particularly with THA. This represents an important factor that may be modified in the setting of total joint arthroplasty but further work will be necessary to study potential alternative medications for depression in the perioperative phase.
选择性 5-羟色胺再摄取抑制剂（SSRIs）在骨科和普通外科文献中均显示与出血风险增加相关，这被认为是通过减少血小板 5-羟色胺摄取和随后血小板聚集潜力下降而发生的。在这项研究中，我们旨在量化 SSRIs 治疗对全髋关节置换术（THA）或全膝关节置换术（TKA）后出血量和输血率的影响。
从 2013 年 1 月至 2017 年 12 月，在调查机构中分别对 THA（4485 例）和 TKA（5584 例）病例进行查询和分析，并从机构数据库中进行分析。根据手术时使用 SSRIs 的情况对患者进行分层。获得患者人口统计学资料、基线凝血功能障碍、术前和术后血红蛋白、输血和住院时间，以比较 2 组。
TKA 组中 SSRIs 使用者的输血率为 3.9%，THA 组为 8.5%。在控制年龄、性别、体重指数、凝血功能障碍、手术（THA 与 TKA）和 SSRIs 状态后，SSRIs 的使用与出血量增加显著相关（P<.004），并且控制相同变量的逻辑回归显示 SSRIs 的使用与输血相关（优势比，1.476；P<.001）。
SSRIs 的使用与围手术期出血量增加相关，并且与输血风险相关，尤其是与 THA 相关。这是全关节置换术中可能改变的一个重要因素，但需要进一步研究围手术期抑郁的潜在替代药物。
