Bleeding Risk Following Total Shoulder Arthroplasty in Patients Using Selective Serotonin Reuptake Inhibitors

The purpose of the current study is to evaluate the association between selective serotonin reuptake inhibitor (SSRI) use and the risk of perioperative bleeding and blood transfusion following total shoulder arthroplasty.

The PearlDiver (PearlDiver Technologies, Colorado Springs, CO, USA) Mariner170 database was queried to conduct this retrospective cohort study. Patients were included if they were over 18 years, had anxiety or depression, and underwent primary TSA. Eligible patients were stratified by SSRI use and 1:1 case-control matched by age, gender, Charlson Comorbidity Index (CCI), and relevant comorbidities. Patient demographics and 30-day postoperative outcomes, including bleeding, transfusion, deep venous thrombosis, or pulmonary embolism, were extracted and compared across cohorts.

The SSRI and control groups each contained 3,346 patients who underwent anatomic or reverse TSA. For each group, the mean age was 67.45 ± 7.44 years with 2,410 (72.03%) males and a mean CCI of 1.04 ± 1.07. There were no significant differences (p <0.05) in the risk of postoperative bleeding, transfusion, deep venous thrombosis, or pulmonary embolism between patients with anxiety and/or depression on SSRIs and those not using SSRIs.

The current study determined that there was no increased bleeding or thrombotic risk in patients with anxiety or depression on SSRIs undergoing TSA compared to those not using SSRIs. These findings do not provide support for the alteration of SSRI regimens in the TSA perioperative period due to bleeding or thrombotic risk. However, caution should still be used in patients on SSRIs undergoing TSA.