Nemeth Alexander, Rahimi Kayvon, Karande Sachin, Romasco Tea, Lowenstein Adam, Pereira Rodrigo Dos Santos, Mourão Carlos Fernando
Department of Basic and Clinical Translational Sciences, School of Dentistry, Tufts University, Boston, MA 02111, USA.
Department of Oral & Maxillofacial Surgery, University of Grande Rio-UNIGRANRIO, Rio de Janeiro 25071-202, Brazil.
J Clin Med. 2025 Aug 30;14(17):6140. doi: 10.3390/jcm14176140.
This review aimed to evaluate whether patients undergoing dental extractions while taking antidepressants experience increased intra-operative or post-operative bleeding compared to patients not taking these medications. A comprehensive literature search was conducted across PubMed, EMBASE, Web of Science, Scopus, and ClinicalTrials.gov for randomized controlled trials (RCTs) published before 17 August 2025. Studies were included if they compared bleeding outcomes between antidepressant users and non-users undergoing dental extraction procedures. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42025645035). Of 689 studies screened, no RCTs met the eligibility criteria. Only one retrospective study, which did not match the inclusion criteria, identified a 1% incidence of bleeding complications in users of selective serotonin reuptake inhibitors (SSRIs) undergoing invasive dental procedures. However, it lacked a control group and standardized methodology, so this study was included in the discussion section. The lack of high-quality evidence, especially studies examining dynamic coagulation parameters like bleeding time and prothrombin time before and after antidepressant use, highlights a significant gap in the research. These findings emphasize the urgent need for well-designed clinical trials to determine the potential effect of antidepressants on bleeding risk.
本综述旨在评估与未服用抗抑郁药的患者相比，正在服用抗抑郁药的患者在拔牙时术中或术后出血是否增加。在PubMed、EMBASE、Web of Science、Scopus和ClinicalTrials.gov上进行了全面的文献检索，以查找2025年8月17日前发表的随机对照试验（RCT）。如果研究比较了服用抗抑郁药者和未服用抗抑郁药者在拔牙过程中的出血结果，则纳入该研究。本综述遵循系统评价和Meta分析的首选报告项目（PRISMA）指南，并在国际前瞻性系统评价注册库（PROSPERO，CRD42025645035）注册。在筛选的689项研究中，没有RCT符合纳入标准。仅有一项不符合纳入标准的回顾性研究发现，接受侵入性牙科手术的选择性5-羟色胺再摄取抑制剂（SSRI）使用者中出血并发症的发生率为1%。然而，该研究缺乏对照组和标准化方法，因此在讨论部分纳入了此项研究。缺乏高质量证据，尤其是缺乏研究抗抑郁药使用前后出血时间和凝血酶原时间等动态凝血参数的研究，凸显了研究中的重大差距。这些发现强调迫切需要设计良好的临床试验，以确定抗抑郁药对出血风险的潜在影响。
