TY - JOUR

T1 - Psychopharmacologic treatment and blood transfusion in fast-track total hip and knee arthroplasty

AU - Gylvin, Silas Hinsch

AU - Jorgensen, Christoffer Calov

AU - Fink-Jensen, Anders

AU - Johansson, Par I.

AU - Kehlet, Henrik

PY - 2017

Y1 - 2017

N2 - BACKGROUNDSelective serotonin reuptake inhibitors (SSRIs) and other psychotropics are receiving increasing attention due to reports on inhibition of thrombocyte function and an increased bleeding risk in surgical settings. Studies in total hip and total knee arthroplasty (THA and TKA, respectively) have shown conflicting results, questioning whether the potential increased bleeding risk is of clinical importance.STUDY DESIGN AND METHODSProspective consecutive collection of data on preoperative comorbidity in patients undergoing primary unilateral THA or TKA was cross-referenced with regional transfusion databases and The Danish National Database of Reimbursed Prescriptions for information regarding blood transfusions and psychopharmacologic treatment. All participating orthopedic centers followed similar perioperative guidelines. Multiple logistic regression analysis was applied to calculate odds ratios (ORs) for transfusion between preoperative users and nonusers of psychotropics.RESULTSOf 8402 patients, 569 (6.8%) were SSRI users versus 7833 (93.2%) nonusers. A total of 109 (19,2%) patients in the SSRI group and 700 (8.9%) in the “no-SSRI” group received blood intra- or postoperatively. Preoperative SSRI treatment was a risk factor for perioperative transfusion (OR, 1.98; 95% confidence interval [CI], 1.44-2.70). Other antidepressants (OAs) were associated with an increased risk of transfusion (OR, 1.69; 95% CI, 1.17-2.44) as well as the combination of SSRIs and OAs (OR, 3.31; 95% CI, 1.79-6.13). Singular use of antipsychotics (APs) increased the transfusion risk (OR, 2.37; 95% CI, 1.04-2.41), while AP medicine in combination with antidepressants did not.CONCLUSIONSPreoperative treatment with SSRIs, OAs, or APs are independent risk factors for blood transfusion in elective fast-track THA and TKA.

AB - BACKGROUNDSelective serotonin reuptake inhibitors (SSRIs) and other psychotropics are receiving increasing attention due to reports on inhibition of thrombocyte function and an increased bleeding risk in surgical settings. Studies in total hip and total knee arthroplasty (THA and TKA, respectively) have shown conflicting results, questioning whether the potential increased bleeding risk is of clinical importance.STUDY DESIGN AND METHODSProspective consecutive collection of data on preoperative comorbidity in patients undergoing primary unilateral THA or TKA was cross-referenced with regional transfusion databases and The Danish National Database of Reimbursed Prescriptions for information regarding blood transfusions and psychopharmacologic treatment. All participating orthopedic centers followed similar perioperative guidelines. Multiple logistic regression analysis was applied to calculate odds ratios (ORs) for transfusion between preoperative users and nonusers of psychotropics.RESULTSOf 8402 patients, 569 (6.8%) were SSRI users versus 7833 (93.2%) nonusers. A total of 109 (19,2%) patients in the SSRI group and 700 (8.9%) in the “no-SSRI” group received blood intra- or postoperatively. Preoperative SSRI treatment was a risk factor for perioperative transfusion (OR, 1.98; 95% confidence interval [CI], 1.44-2.70). Other antidepressants (OAs) were associated with an increased risk of transfusion (OR, 1.69; 95% CI, 1.17-2.44) as well as the combination of SSRIs and OAs (OR, 3.31; 95% CI, 1.79-6.13). Singular use of antipsychotics (APs) increased the transfusion risk (OR, 2.37; 95% CI, 1.04-2.41), while AP medicine in combination with antidepressants did not.CONCLUSIONSPreoperative treatment with SSRIs, OAs, or APs are independent risk factors for blood transfusion in elective fast-track THA and TKA.

U2 - 10.1111/trf.13992

DO - 10.1111/trf.13992

M3 - Journal article

C2 - 28145024

VL - 57

SP - 971

EP - 976

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 4

ER -