AMELİYAT DÖNEMİNDE SSRI GRUBU ANTİDEPRESSAN KULLANMAYIN!

klinik farmakoloji dosyası
Haber

Ameliyat döneminde (perioperatif) SSRI grubu antidepressan (Prozac, Lustral,Paxil vs) kullananlarda kanama riski,transfüzyon, tekrar hastaneye yatma ve ölüm anlamlı olarak artıyor.
JAMA da 29 Nisanda yayınlanan, 2006-2008 yıllarında ABD de 375 hastanede yapılan 530,416 (beşyüzotuzbindörtyüzonaltı) hastayı kapsayan araştırmaya göre ameliyat döneminde SSRI kullananlarda ölüme kadar giden yan etkiler ortaya çıkmakta. Daha önce ağrı kesici veya warfarin kullanlarda SSRI lerin kanama riskini artırdığı gösterilmişti.
Bu çalışmada ameliyat döneminde (önce-sırasında-sonra) SSRI kullanan 72.540 hasta SSRI kullanmayan 457.876 hasta ile kıyaslanmış. Araştırmada hastanede ölümler, hastanede yatış süresi, 30 gün içinde tekrar hastaneye yatış, kanama olayları, transfüzyon ve ventriküler aritmiler ve ani ölümler kaydedilmiş. Hastaların çoğunluğu sertarlin (Lustral ve diğerleri), fluoxetine (Prozac ve diğerleri), paroxetine (Paxil, Serosat gibi), citalopram (Cipram ve benzerleri) ve fluvoxamine (Faverin ve benzerleri) kullanmaktaydı.
Perioperative Use of Selective Serotonin Reuptake Inhibitors and Risks for Adverse Outcomes of Surgery ONLINE FIRST
Andrew D. Auerbach, MD, MPH; Eric Vittinghoff, PhD; Judith Maselli, MSPH; Penelope S. Pekow, PhD; John Q. Young, MD; Peter K. Lindenauer, MD, MS
JAMA Intern Med. 2013;():1-7. Published online April 29, 2013

ABSTRACT |

Importance Single-site studies have described an association between use of selective serotonin reuptake inhibitors (SSRIs) and adverse outcomes of surgery. Multicenter studies including a broad range of surgical procedures that explore rare outcomes, such as bleeding and mortality, and that account for indications for administration of SSRIs are needed.
Objective To determine whether perioperative use of SSRIs is associated with adverse outcomes of surgery in a national sample of patients.
Design Retrospective study of patients 18 years or older who underwent major surgery from January 1, 2006, through December 31, 2008, at 375 US hospitals. We used multivariable hierarchical models to estimate associations between SSRI use and our outcomes. Pharmacy data were used to determine whether a patient received an SSRI in the perioperative period.
Setting Three hundred seventy-five US hospitals.
Participants Five hundred thirty thousand four hundred sixteen patients 18 years or older.
Exposure Perioperative use of SSRIs.
Main Outcomes and Measures In-hospital mortality, length of stay, readmission at 30 days, bleeding events, transfusions, and incidence of ventricular arrhythmias.
Results Patients receiving SSRIs were more likely to have obesity, chronic pulmonary disease, or hypothyroidism (P < .001 for each) and more likely to have depression (41.0% vs 6.2%, P < .001). After adjustment, patients receiving SSRIs had higher odds of in-hospital mortality (adjusted odds ratio, 1.20 [95% CI, 1.07-1.36]), bleeding (1.09 [1.04-1.15]), and readmission at 30 days (1.22 [1.18-1.26]). Similar results were observed in propensity-matched analyses, although the risk of inpatient mortality was attenuated among patients with depression. Sensitivity analyses suggest that, to invalidate our results, an unmeasured covariate would have to have higher prevalence and be more strongly associated with mortality than any covariate included in our models.
Conclusions and Relevance Receiving SSRIs in the perioperative period is associated with a higher risk for adverse events. Determining whether patient factors or SSRIs themselves are responsible for elevated risks requires prospective study.