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Psychopharmacologic treatment and blood transfusion in fast‐track total hip and knee arthroplasty
Author(s) -
Gylvin Silas Hinsch,
Jørgensen Christoffer Calov,
FinkJensen Anders,
Johansson Pär I.,
Kehlet Henrik
Publication year - 2017
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13992
Subject(s) - medicine , perioperative , odds ratio , confidence interval , blood transfusion , arthroplasty , comorbidity , orthopedic surgery , blood management , surgery , anesthesia
BACKGROUND Selective 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 METHODS Prospective 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. RESULTS Of 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. CONCLUSIONS Preoperative treatment with SSRIs, OAs, or APs are independent risk factors for blood transfusion in elective fast‐track THA and TKA.