Considering the risks of comorbid depression in patients with cardiac conditions, the importance of optimal antidepressant therapy is underscored. Because there is documented increased risk of bleeding in certain predisposed patients, previous studies have been conducted to evaluate the potential for bleeding and perioperative complications in patients undergoing cardiac surgery who have a predisposed theoretic bleeding risk. These studies have resulted in unclear associations, however, so lead author, Mark. M Smith, MD, and his team, conducted a study with findings published in Anesthesia & Analgesia. Dr. Smith is affiliated with the Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
This study evaluated the potential risk of perioperative bleeding, transfusion, morbidity, and mortality in a total of 1,417 patient pairs, including those taking SSRI/SNRI antidepressants and matched controls who were not taking the antidepressant medications at the time of cardiac surgery. The team evaluated the need for perioperative blood transfusion, chest tube output, and reoperation for bleeding as primary outcomes with secondary outcomes, including postoperative complications such as renal failure, stroke or transient ischemic accident, prolonged mechanical ventilation, perioperative myocardial infarction, intensive care unit (ICU) and hospital length of stay (LOS), as well as 30-day mortality.
The research team found no significant difference in postsurgical chest tube output (median, 750 vs. 750 mL; P = 0.860), bleeding requiring surgical intervention (2.8% vs. 2.5%; P = 0.892) or for transfusion rates (with the overall perioperative transfusion rate for SSRI/SNRI patients 66.5% vs. 64.9% for matched controls P = 0.697). Patients in the SSRI/SNRI group did, however, experience a higher rate of prolonged mechanical ventilation (13.1% vs. 8.6%; P = 0.002), longer ICU LOS (median, 25.5 vs. 23.8 hours; P <0.001), and longer hospital LOS (median, 6.0 vs. 5.0 days; P <0.001).
The study authors highlighted the importance of these findings, noting that because no additional bleeding risk was observed, perioperative interruption of antidepressant therapy is not necessary and may lead to unnecessary destabilization of the patient’s mental health condition. Further research is warranted to explore the role of SSRI/SNRI antidepressants on the secondary outcome of longer length of stay because of other medication-related effects or as consequence of the underlying mental health condition.
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