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Selective Serotonin Reuptake Inhibitors (SSRIs) and Surgical Bleeding in Plastic Surgery: A Systematic Review.
Nathan John1, Francisco A Ferri2, Emanuella M Brito3
1General Surgery, Cleveland Clinic Florida, Weston, USA.
Cureus
|March 28, 2025
Summary
Selective serotonin reuptake inhibitors (SSRIs) increase bleeding risk in plastic surgery, particularly hematoma reoperations for breast procedures. Further research is needed for facial surgeries due to limited data.
Area of Science:
- Plastic and Reconstructive Surgery
- Pharmacology
- Hematology
Background:
- Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for psychiatric disorders.
- SSRIs can impair hemostasis by affecting platelet aggregation, potentially increasing bleeding risk.
- The clinical implications of SSRI use in plastic and reconstructive surgeries (PRS) require careful consideration due to bleeding risks versus discontinuation syndromes.
Purpose of the Study:
- To systematically review the literature on the association between SSRI consumption and bleeding outcomes in plastic and reconstructive surgeries.
- To evaluate the risk of bleeding complications in soft-tissue procedures among patients using SSRIs.
Main Methods:
- A systematic review was conducted using the National Center for Biotechnology Information (NCBI) and Embase databases.
- Publications investigating SSRI use and bleeding outcomes in PRS and soft-tissue procedures were identified.
- Five retrospective cohort studies were included, though heterogeneity in study designs and outcomes precluded meta-analysis.
Main Results:
- Overall post-operative bleeding rates ranged from 1.9% to 2.6%.
- Studies indicated an increased risk of hematoma reoperations for breast cosmetic (OR 4.14) and oncologic (OR 2.7) procedures in patients on SSRIs.
- No significant increase in bleeding events was found for facial procedures in two low-power studies, and one study found no increased risk of blood transfusion.
Conclusions:
- The risk of significant bleeding complications in breast and facial PRS appears low, with SSRI use associated with a less than 5% increase in hematoma reoperations for breast procedures.
- Current evidence on SSRI-related bleeding in facial plastic surgery is limited by study quality, often relying on case reports.
- Further high-level research, particularly on facial, extremity, and flap surgeries, is necessary to fully elucidate SSRI-related bleeding risks.