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比较选择性 5-羟色胺再摄取抑制剂使用者和非使用者患者血栓弹力图的术前血小板功能。

Comparison of pre-operative platelet functions by thromboelastogram in patients selective serotonin reuptake inhibitors user and non-user.

机构信息

Department of Anesthesiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya-Turkey.

出版信息

Ulus Travma Acil Cerrahi Derg. 2022 Mar;28(3):276-280. doi: 10.14744/tjtes.2020.96892.

DOI:10.14744/tjtes.2020.96892
PMID:35485575
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10493526/
Abstract

BACKGROUND

The use of antidepressant drugs, in particular selective serotonin reuptake inhibitors (SSRIs), has increased in recent years. Using SSRIs can cause changes in serotonin metabolism. Serotonin provides platelet aggregation and plays a role in the regulation of vascular tone and coagulation processes. The aim of this study was to evaluate the effects of SSRI use on coagulation functions with thromboelastogram (TEG) in patients undergoing surgical operation and to compare with non-user cases.

METHODS

The study was designed for 60 patients whose physical status was classified according to the American Society of Anes-thesiology (ASA) classification as ASA I-II were included in the study. During routine pre-operative blood tests, 2 ml complete blood sample used and TEG performed. The cases were divided into two groups as SSRI user and non-user and analyzed.

RESULTS

R value was higher in SSRI user patients than in non-user patients. The MA value was significantly lower in SSRI user. There was no statistically significant difference in other parameters. In the evaluation based on duration of SSRI use, there was no statistically significant difference between those whose duration of use was more than 1 year and <1 year.

CONCLUSION

When the coagulation process was evaluated by TEG method, it was seen that the onset of clotting was prolonged and thrombus formation was slowed down in SSRI users. The results did not reveal that SSRI alone was the cause of bleeding, but it was concluded that slowing the process might be important, especially for surgical operations.

摘要

背景

近年来,抗抑郁药的使用(尤其是选择性 5-羟色胺再摄取抑制剂(SSRIs))有所增加。使用 SSRIs 会导致 5-羟色胺代谢发生变化。5-羟色胺能提供血小板聚集,并在调节血管张力和凝血过程中发挥作用。本研究旨在通过血栓弹力图(TEG)评估手术患者使用 SSRIs 对凝血功能的影响,并与非使用者进行比较。

方法

本研究设计纳入了 60 名根据美国麻醉师协会(ASA)分级为 ASA I-II 级的患者。在常规术前血液检查中,使用 2ml 全血样本进行 TEG 检查。将患者分为 SSRIs 使用者和非使用者两组并进行分析。

结果

SSRIs 使用者的 R 值高于非使用者。SSRIs 使用者的 MA 值明显较低。其他参数无统计学差异。在基于 SSRIs 使用时间的评估中,使用时间超过 1 年和<1 年的患者之间无统计学差异。

结论

通过 TEG 方法评估凝血过程时,发现 SSRIs 使用者的凝血起始时间延长,血栓形成速度减慢。结果并未表明 SSRIs 是导致出血的唯一原因,但可以得出结论,减慢这一过程可能很重要,特别是对于手术操作。

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本文引用的文献

1
Selective Serotonin Reuptake Inhibitors and Operative Bleeding Risk: A Review of the Literature.选择性5-羟色胺再摄取抑制剂与手术出血风险:文献综述
J Clin Psychopharmacol. 2016 Dec;36(6):704-709. doi: 10.1097/JCP.0000000000000575.
2
Decreased serotonin content and reduced agonist-induced aggregation in platelets of patients chronically medicated with SSRI drugs.慢性服用 SSRI 类药物的患者血小板中 5-羟色胺含量降低,且激动剂诱导的聚集减少。
J Affect Disord. 2012 Jan;136(1-2):99-103. doi: 10.1016/j.jad.2011.08.013. Epub 2011 Sep 4.
3
Coagulation activation and fibrinolysis impairment are reduced in patients with anxiety and depression when medicated with serotonergic antidepressants.焦虑和抑郁患者在接受 5-羟色胺能抗抑郁药治疗时,凝血激活和纤维蛋白溶解受损减少。
Psychiatry Clin Neurosci. 2011 Aug;65(5):518-25. doi: 10.1111/j.1440-1819.2011.02241.x.
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Antidepressant use and risk of adverse outcomes in older people: population based cohort study.抗抑郁药的使用与老年人不良结局风险:基于人群的队列研究。
BMJ. 2011 Aug 2;343:d4551. doi: 10.1136/bmj.d4551.
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Use of serotonergic drugs and the risk of bleeding.使用血清素能药物与出血风险。
Clin Pharmacol Ther. 2011 Jan;89(1):89-96. doi: 10.1038/clpt.2010.240. Epub 2010 Nov 24.
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Human blood platelet serotonin studied in vitro: endogenous serotonin may stimulate thrombin-induced serotonin release in stored platelets.人血血小板 5-羟色胺的体外研究:内源性 5-羟色胺可能刺激储存血小板中凝血酶诱导的 5-羟色胺释放。
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Laboratory assessment and perioperative management of patients on antiplatelet therapy: from the bench to the bedside.抗血小板治疗患者的实验室评估与围手术期管理:从实验室到床边
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[Ecchymosis associated with the use of fluoxetine: case report].[氟西汀使用相关的瘀斑:病例报告]
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