Clinical Scorecard: Association of Serotonergic Antidepressants with Elevated Bleeding Incidents in the 30 Days Following Total Shoulder Arthroplasty: A Propensity-Matched Study of 54,291 Patients

At a Glance

Key Highlights

• Use of serotonergic antidepressants (SSRIs/SNRIs) is associated with increased bleeding events post-TSA.
• Propensity-matched analysis of 7,374 patients on SSRIs/SNRIs vs 7,374 not on these medications was performed.
• Bleeding outcomes assessed included post-hemorrhagic anemia, hematoma/hemorrhage, and transfusions within 30 days post-surgery.

Guideline-Based Recommendations

Diagnosis

• Identify patients on SSRIs or SNRIs prior to TSA through medication history.
• Assess baseline coagulation parameters and bleeding risk factors preoperatively.

Management

• Consider the increased bleeding risk associated with perioperative serotonergic antidepressant use when planning TSA.
• Monitor closely for bleeding complications postoperatively in patients on SSRIs/SNRIs.

Monitoring & Follow-up

• Monitor for signs of bleeding including hematoma formation, anemia, and need for transfusion during the first 30 days post-TSA.
• Track emergency department visits, ICU admissions, and hospital readmissions related to bleeding.

Risks

• SSRIs and SNRIs impair platelet aggregation by reducing platelet serotonin, increasing postoperative bleeding risk.
• Bleeding events may lead to increased morbidity including transfusions and reoperations.

Patient & Prescribing Data

Adults undergoing primary total shoulder arthroplasty, including those with psychiatric indications for SSRIs/SNRIs

Patients prescribed SSRIs or SNRIs within one day of TSA have a higher incidence of bleeding complications in the immediate and short-term postoperative period.

Clinical Best Practices

• Perform thorough medication reconciliation to identify serotonergic antidepressant use before TSA.
• Use propensity matching or risk stratification to adjust perioperative management in patients on SSRIs/SNRIs.
• Educate patients about potential increased bleeding risks associated with their antidepressant medications.
• Coordinate multidisciplinary care involving psychiatry and surgery to optimize timing and management of serotonergic antidepressants around TSA.

References

• Prevalence of antidepressant use in adults
• Mechanism of SSRI/SNRI-induced bleeding
• Perioperative bleeding risk with serotonergic antidepressants
• TriNetX Global Collaborative Network