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Use of Selective Serotonin Reuptake Inhibitors Antidepressants and Bleeding Risk in Breast Cosmetic Surgery

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Abstract

Background

Selective serotonin reuptake inhibitors (SSRIs) are the most common antidepressant prescribed currently. Data regarding SSRI use among plastic surgery patients may differ between different populations, but the incidence could be as high as 10 %. It is known that SSRIs decrease platelet serotonin storage and platelet function, and their association with postsurgical bleeding in mastectomy patients and orthopedic surgery patients is well established. An increased risk of postsurgical bleeding among plastic surgery patients may have important clinical implications, but this has not been evaluated to date. The authors therefore conducted a hospital-based study with prospectively collected data to examine the association between the use of SSRIs and postsurgical bleeding. To the authors’ knowledge, this is the first study to evaluate the effects of SSRIs on bleeding risk in the breast cosmetic surgery population.

Methods

All patients who underwent breast cosmetic plastic surgery procedures (breast augmentation, breast reduction, or mastopexy) at our institution between January of 2001 and December of 2011 were reviewed. The patients were divided into two groups by SSRI use history: a no-use group and an active-use group. The primary end point for a bleeding event was the need for intervention. Patients were further subcategorized by type of breast surgery performed, body mass index, and age. Descriptive statistics tabulated the frequency of a bleeding event within the groups. Logistic regression was applied to evaluate the risk of a bleeding event according to the use of SSRIs. The odds ratios (ORs) with their 95 % confidence intervals (CIs) associating SSRI use with postoperative bleeding were computed.

Results

During the study period, 2,285 patients had breast cosmetic surgery, and 33 of these patients (1.44 %) experienced a bleeding event (hematoma requiring surgical draining). Of the 196 patients (8.58 %) in the active-use group, 9 (4.59 %) experienced a bleeding event. Of the 2,089 patients in the no-use group, 24 (1.15 %) presented with bleeding. The patients using SSRIs had a 4.14-fold greater risk of breast hematoma needing intervention than the patients who were not users (OR, 4; 95 % CI, 1.90–9.04). Logistic regression also showed that bleeding events were more common among the SSRI users regardless of the type of procedure performed, the body mass index, or the age group.

Conclusions

Use of SSRIs is associated with a fourfold increased risk of bleeding after breast cosmetic surgery (from 1.44 to 4.59 %). The decision of psychologically vulnerable patients to stop SSRIs before surgery should not be made without a complete discussion of the risks and benefits.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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References

  1. Coogan PF, Palmer JR, Strom BL, Rosenberg L (2005) Use of selective serotonin reuptake inhibitors and the risk of breast cancer. Am J Epidemiol 162:835–838

    Article  PubMed  Google Scholar 

  2. Gärtner R, Cronin-Fenton D, Hundborg HH, Pedersen L, Pedersen L, Lash TL, Sørensen HT, Kroman N (2010) Use of selective serotonin reuptake inhibitors and risk of reoperation due to postsurgical bleeding in breast cancer patients: a Danish population-based cohort study. BMC Surg 10:3

    Article  PubMed  Google Scholar 

  3. Maurer-Spurej E, Pittendreigh C, Solomons K (2004) The influence of selective serotonin reuptake inhibitors on human platelet serotonin. Thromb Haemost 91:119–128

    PubMed  CAS  Google Scholar 

  4. Hergovich N, Aigner M, Eichler HG, Entlicher J, Drucker C, Jilma B (2000) Paroxetine decreases platelet serotonin storage and platelet function in human beings. Clin Pharmacol Ther 68:435–442

    Article  PubMed  CAS  Google Scholar 

  5. Yuan Y, Tsoi K, Hunt RH (2006) Selective serotonin reuptake inhibitors and risk of upper GI bleeding: confusion or confounding. Am J Med 119:719–727

    Article  PubMed  CAS  Google Scholar 

  6. Dalton SO, Johansen C, Mellemkjaer L, Norgard B, Sorensen HT, Olsen JH (2003) Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: a population-based cohort study. Arch Intern Med 163:59–64

    Article  PubMed  CAS  Google Scholar 

  7. Movig KL, Janssen MW, de Waal MJ, Kabel PJ, Leufkens HG, Egberts AC (2003) Relationship of serotonergic antidepressants and need for blood transfusion in orthopedic surgical patients. Arch Intern Med 163:2354–2358

    Article  PubMed  CAS  Google Scholar 

  8. Kim DH, Daskalakis C, Whellan DJ, Whitman IR, Hohmann S, Medvedev S, Kraft WK (2009) Safety of selective serotonin reuptake inhibitor in adults undergoing coronary artery bypass grafting. Am J Cardiol 103:1391–1395 Epub 1 April 2009

    Article  PubMed  CAS  Google Scholar 

  9. Gabriel SE, Woods JE, O’Fallon WM, Beard CM, Kurland LT, Melton LJ III (1997) Complications leading to surgery after breast implantation. N Engl J Med 336:677–682

    Article  PubMed  CAS  Google Scholar 

  10. Cunningham BL, Lokeh A, Gutowski KA (2000) Saline-filled breast implant safety and efficacy: a multicenter retrospective review. Plast Reconstr Surg 105:2143–2149

    Article  PubMed  CAS  Google Scholar 

  11. Kjøller K, Hölmich LR, Jacobsen PH, Friis S, Fryzek J, McLaughlin JK, Lipworth L, Henriksen TF, Jørgensen S, Bittmann S, Olsen JH (2002) Epidemiological investigation of local complications after cosmetic breast implant surgery in Denmark. Ann Plast Surg 48:229–237

    Article  PubMed  Google Scholar 

  12. Basile FV, Basile AR (2012) Reoperative transaxillary breast surgery: using the axillary incision to treat augmentation-related complications. Aesthet Plast Surg 36:323–330

    Article  Google Scholar 

  13. Broughton G II, Crosby MA, Coleman J, Rohrich RJ (2007) Use of herbal supplements and vitamins in plastic surgery: a practical review. Plast Reconstr Surg 119:48e–66e

    Article  PubMed  Google Scholar 

  14. Collins JB, Verheyden CN (2012) Incidence of breast hematoma after placement of breast prostheses. Plast Reconstr Surg 129:413e–420e

    Article  PubMed  Google Scholar 

  15. Hakelius L, Ohlse L (1992) A clinical comparison of the tendency to capsular contracture between smooth and textured gel-filled silicone mammary implants. Plast Reconstr Surg 90:247–254

    PubMed  CAS  Google Scholar 

  16. Lavine DM (1993) Saline inflatable prostheses: 14 years experience. Aesthet Plast Surg 17:325–330

    Article  CAS  Google Scholar 

  17. Williams JE (1972) Experiences with a large series of silastic breast implants. Plast Reconstr Surg 49:253–258

    Article  PubMed  CAS  Google Scholar 

  18. Antony AK, McCarthy CM, Cordeiro PG (2010) Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: determining the incidence and significant predictors of complications. Plast Reconstr Surg 125:1606–1614

    Article  PubMed  CAS  Google Scholar 

  19. Codner MA, Mejia JD, Locke MB, Mahoney A, Thiels C, Nahai FR, Hester TR, Nahai F (2011) A 15-year experience with primary breast augmentation. Plast Reconstr Surg 127:1300–1310

    Article  PubMed  CAS  Google Scholar 

  20. Abajo FJ (2011) Effects of selective serotonin reuptake inhibitors on platelet function: mechanisms, clinical outcomes, and implications for use in elderly patients. Drugs Aging 28:345–367

    Article  PubMed  Google Scholar 

  21. Schatzberg AF, Haddad P, Kaplan EM, Lejoyeux M, Rosenbaum JF, Young AH, Zajecka J (1997) Serotonin reuptake inhibitor discontinuation syndrome: A hypothetical definition. Discontinuation consensus panel. J Clin Psychiatry 58(Suppl 7):5–10

    PubMed  CAS  Google Scholar 

  22. Dominguez RA, Goodnick PJ (1995) Adverse events after the abrupt discontinuation of paroxetine. Pharmacotherapy 15:778–780

    PubMed  CAS  Google Scholar 

  23. Judge R, Parry MG, Quail D, Jacobson JG (2002) Discontinuation symptoms: comparison of brief interruption in fluoxetine and paroxetine treatment. Psychopharmacology 17:217–225

    CAS  Google Scholar 

  24. Lejoyeux M, Adès J (1997) Antidepressant discontinuation: a review of the literature. J Clin Psychiatry 58(Suppl 7):11–15 discussion 16, 1997

    PubMed  CAS  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Filipe Volpe Basile.

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Basile, F.V., Basile, A.R. & Basile, V.V. Use of Selective Serotonin Reuptake Inhibitors Antidepressants and Bleeding Risk in Breast Cosmetic Surgery. Aesth Plast Surg 37, 561–566 (2013). https://doi.org/10.1007/s00266-013-0111-7

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  • DOI: https://doi.org/10.1007/s00266-013-0111-7

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