SSRIs Depressing Perioperative Outcomes?
Accumulating clinical evidence, supported by biological rationale, supports a statistically significant impact of SSRIs on the risk of bleeding. However the current data do not unequivocally support this to be of clinically importance in the preoperative period. The first step is to confirm these early reports with further observational data; however, this alone will not necessarily inform us how to manage SSRIs at this time. To understand this a large randomised controlled trial of the discontinuation vs continuation of therapy is required. Clinicians should be aware that SSRI's may contribute to perioperative bleeding and mortality and in individual patients at high risk of this complication may choose to actively discontinue the SSRI. Any future research should carefully examine this perioperative bleeding risk alongside overall outcome.
Many commonly administered medications which have benefits more strongly geared towards secondary prevention and improving quality of life have inconsistent benefits in the operative arena, yet many patients present for anaesthesia and surgery on a combination of aspirin, beta blockers, statins, angiotensin converting enzyme inhibitors and antidepressants. More recent evidence has questioned the perceived benefit of some of these drugs. Further observational data are required on the effects of these drugs, singularly and in combination.
Conclusions
Accumulating clinical evidence, supported by biological rationale, supports a statistically significant impact of SSRIs on the risk of bleeding. However the current data do not unequivocally support this to be of clinically importance in the preoperative period. The first step is to confirm these early reports with further observational data; however, this alone will not necessarily inform us how to manage SSRIs at this time. To understand this a large randomised controlled trial of the discontinuation vs continuation of therapy is required. Clinicians should be aware that SSRI's may contribute to perioperative bleeding and mortality and in individual patients at high risk of this complication may choose to actively discontinue the SSRI. Any future research should carefully examine this perioperative bleeding risk alongside overall outcome.
Many commonly administered medications which have benefits more strongly geared towards secondary prevention and improving quality of life have inconsistent benefits in the operative arena, yet many patients present for anaesthesia and surgery on a combination of aspirin, beta blockers, statins, angiotensin converting enzyme inhibitors and antidepressants. More recent evidence has questioned the perceived benefit of some of these drugs. Further observational data are required on the effects of these drugs, singularly and in combination.
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