術後使用抗憂鬱藥沒有出血風險


  【24drs.com】新研究指出,頭頸部整形手術患者,使用選擇性血清素再吸收抑制劑(SSRI)或血清素正腎上腺素再吸收抑制劑(SNRI)與出血風險增加無關。
  
  紐澤西醫學與牙醫大學耳鼻咽喉-頭頸外科部Sanaz Harirchian醫師等人寫道,我們發現並無證據支持在手術期間停用SSRIs。
  
  研究刊載於7/8月版顏面整形手術期刊。
  
  血腫形成是除皺術最常見的併發症,發生率為0.2%-8.1%,最近,SSRIs因為可能有出血風險而被進行檢視。
  
  作者們寫道,目前的理論提出血清素會抑制吸收血小板,導致血小板的止血反應降低;雖然觀察型研究及案例報告指出與SSRIs出血風險有關,但是缺乏臨床試驗與等級一的證據。
  
  他們指出,就我們所知,這是首度評估SSRIs對臉部整形文獻之術後出血影響的研究。
  
  他們回顧了2010年1月至 2011年5月間、250名接受臉部深處平面整型病患和13名頸部整型病患的病歷;263名病患中,58人(22%)在手術時有使用SSRIs或SNRIs。
  
  作者們表示,發生1例需要手術介入的嚴重出血併發症,血腫總發生率為0.38%;病患是名接受除皺紋手術的62歲女性,服用低劑量SSRI,她沒有凝血功能障礙病史,並未服用任何已知的非類固醇抗發炎藥物或阿斯匹靈,血腫出現在術後的12小時內,且需要手術解決。
  
  整體(嚴重加上輕微)血腫比率方面,非SSRI/SNRI使用者為1.95% (5名病患)、SSRI/SNRI使用者為1.72% (1名病患)。
  
  研究者表示,他們的研究受限於強度低,無法建立使用SSRI和術後出血之因果關係。
  
  研究者寫道,雖然這篇研究無法明確排除使用SSRIs的術後出血風險微幅增加,我們可以結論指出,使用SSRI者的血腫率小,和已發表的嚴重血腫比率相當;此外,非SSRI使用者和使用者之間的整體血腫率也相當。
  
  作者們也指出,SSRI的使用率22%也顯著反映出這群病患的憂鬱和焦慮盛行率;基於停用SSRIs的風險,使用者的低血腫率和缺乏等級一證據支持出血,我們的研究並未發現在手術前後停用SSRIs的好理由。
  
  資料來源: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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