术后使用抗忧郁药没有出血风险


  【24drs.com】新研究指出,头颈部整形手术患者,使用选择性血清素再吸收抑制剂(SSRI)或血清素正肾上腺素再吸收抑制剂(SNRI)与出血风险增加无关。
  
  纽泽西医学与牙医大学耳鼻咽喉-头颈外科部Sanaz Harirchian医师等人写道,我们发现并无证据支持在手术期间停用SSRIs。
  
  研究刊载于7/8月版颜面整形手术期刊。
  
  血肿形成是除皱术最常见的并发症,发生率为0.2%-8.1%,最近,SSRIs因为可能有出血风险而被进行检视。
  
  作者们写道,目前的理论提出血清素会抑制吸收血小板,导致血小板的止血反应降低;虽然观察型研究及案例报告指出与SSRIs出血风险有关,但是缺乏临床试验与等级一的证据。
  
  他们指出,就我们所知,这是首度评估SSRIs对脸部整形文献之术后出血影响的研究。
  
  他们回顾了2010年1月至 2011年5月间、250名接受脸部深处平面整型病患和13名颈部整型病患的病历;263名病患中,58人(22%)在手术时有使用SSRIs或SNRIs。
  
  作者们表示,发生1例需要手术介入的严重出血并发症,血肿总发生率为0.38%;病患是名接受除皱纹手术的62岁女性,服用低剂量SSRI,她没有凝血功能障碍病史,并未服用任何已知的非类固醇抗发炎药物或阿斯匹灵,血肿出现在术后的12小时内,且需要手术解决。
  
  整体(严重加上轻微)血肿比率方面,非SSRI/SNRI使用者为1.95% (5名病患)、SSRI/SNRI使用者为1.72% (1名病患)。
  
  研究者表示,他们的研究受限于强度低,无法建立使用SSRI和术后出血之因果关系。
  
  研究者写道,虽然这篇研究无法明确排除使用SSRIs的术后出血风险微幅增加,我们可以结论指出,使用SSRI者的血肿率小,和已发表的严重血肿比率相当;此外,非SSRI使用者和使用者之间的整体血肿率也相当。
  
  作者们也指出,SSRI的使用率22%也显著反映出这群病患的忧郁和焦虑盛行率;基于停用SSRIs的风险,使用者的低血肿率和缺乏等级一证据支持出血,我们的研究并未发现在手术前后停用SSRIs的好理由。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6882&x_classno=0&x_chkdelpoint=Y
  

No Bleeding Risk With Antidepressants Following Surgery

By Megan Brooks
Medscape Medical News

July 16, 2012 — Use of a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI) by patients having face- and neck-lift procedures is not associated with an increased risk of bleeding, new research indicates.

"We found no evidence to support discontinuing SSRIs perioperatively," the authors, led by Sanaz Harirchian, MD, Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey in Newark, and colleagues write.

The study is published in the July/August issue of Archives of Facial Plastic Surgery.

Hematoma formation is the most common complication of rhytidectomy, with an incidence of 0.2% to 8.1%. Recently, SSRIs have come under scrutiny because of possible bleeding risks.

The current theory "proposes an inhibition of serotonin uptake into platelets, leading to an impairment in the platelet hemostatic response. While there are observational studies and case reports of hemorrhagic risks associated with SSRIs, clinical trials and level I evidence are lacking," the authors write.

"To our knowledge, this is first study evaluating the effects of SSRIs on postoperative bleeding in the facial plastics literature," they add.

They reviewed the charts of 250 consecutive patients who underwent a modified deep-plane face-lift and 13 patients who underwent neck-lift from January 2010 to May 2011.

Among all 263 patients, 58 (22%) were using SSRIs or SNRIs at the time of surgery.

"One major bleeding complication occurred, requiring surgical intervention, resulting in a total hematoma rate of 0.38%," the authors say. The patient was a 62-year-old woman taking a low-dose SSRI who underwent revision rhytidectomy. She had no history of coagulopathy and was not taking any known nonsteroidal anti-inflammatory drugs or aspirin. The hematoma manifested within the first 12 postoperative hours, requiring surgical evacuation.

The total hematoma rate (major plus minor) was 1.95% (5 patients) for non–SSRI/SNRI users vs 1.72% (1 patient) for SSRI/SNRI users.

The researchers say their study is limited by its "low power," and they cannot establish a causal relationship between SSRI use and postoperative bleeding.

"While this study cannot definitely rule out a small increased risk of postoperative bleeding with the usage of SSRIs, we can conclude that the rate of hematoma among SSRI users is small and comparable with published rates of major hematoma. In addition, the rates of total hematoma between non–SSRI users and SSRI users are comparable," the investigators write.

The authors also note that the 22% rate of SSRI use is "significant and reflects the prevalence of depression and anxiety in this group of patients. Given the risk of cessation of SSRIs, the low hematoma rate among users and the lack of level I evidence supporting bleeding, our study does not find good reason to stop SSRIs in the perioperative period."

The authors have disclosed no relevant financial relationships.

Arch Facial Plast Surg. 2012;14:248-252.

    
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