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Selective Serotonin Reuptake Inhibitor Use and Perioperative Bleeding and Mortality in Patients Undergoing Coronary Artery Bypass Grafting: A Cohort Study

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Abstract

Introduction

Several small studies have reported inconsistent findings about the safety of selective serotonin reuptake inhibitors (SSRIs) among patients undergoing coronary artery bypass grafting (CABG). We sought to investigate post-CABG bleeding and mortality outcomes related to antidepressant exposure.

Methods

We identified patients who underwent CABG between 2004 and 2008 in the Premier Perspective Comparative Database. We determined whether they received SSRIs, other antidepressants, or no antidepressants on any pre-CABG hospital day and used Cox proportional hazards models to compare bleeding and mortality rates among the exposure groups while adjusting for potential confounders based on administrative data, pre-CABG charge codes, and discharge diagnosis codes.

Results

We identified 132,686 eligible patients: 7112 exposed to SSRIs, 1905 exposed to other antidepressants, and 123,668 unexposed. As compared with no exposure, neither SSRIs (hazard ratio [HR] 0.98; 95 % confidence interval [CI] 0.90–1.07) nor other antidepressants (HR 1.11; 95 % CI 0.96–1.28) increased major bleeds, and neither SSRIs (HR 0.93; 95 % CI 0.80–1.07) nor other antidepressants (HR 0.84; 95 % CI 0.62–1.14) increased mortality. Both SSRIs (HR 1.14; 95 % CI 1.10–1.18) and other antidepressants (HR 1.11; 95 % CI 1.03–1.19) were associated with a slight increase in receipt of one or more packed red blood cell (pRBC) units, but neither were associated with substantial increases in receipt of three or more pRBC units (HR 1.06; 95 % CI 0.96–1.17 for SSRIs; HR 1.09; 95 % CI 0.91–1.31 for other antidepressants).

Conclusion

In this large cohort study, neither SSRIs nor other antidepressants were associated with elevated rates of major bleed, or in-hospital mortality.

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Authors and Affiliations

  1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, USA

    Joshua J. Gagne, Michael A. Fischer, John D. Seeger, Jessica M. Franklin, Jun Liu, Sebastian Schneeweiss & Niteesh K. Choudhry

  2. CVS Health, Woonsocket, RI, USA

    Jennifer M. Polinski

  3. Aetion, Inc., New York, NY, USA

    Jeremy A. Rassen

Authors
  1. Joshua J. Gagne
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  2. Jennifer M. Polinski
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  3. Jeremy A. Rassen
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  4. Michael A. Fischer
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  5. John D. Seeger
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  6. Jessica M. Franklin
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  7. Jun Liu
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  8. Sebastian Schneeweiss
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  9. Niteesh K. Choudhry
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Corresponding author

Correspondence to Joshua J. Gagne.

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Funding

No sources of funding were used to assist in the preparation of this study.

Conflicts of interest

Joshua J. Gagne was previously Principal Investigator of investigator-initiated grants to the Brigham and Women’s Hospital from Novartis Pharmaceuticals Corporation for methods research unrelated to the topic of the study. He is a consultant to Aetion, Inc. Jennifer M. Polinski and Jeremy A. Rassen were employees of the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School at the time that this study was conducted. Jeremy A. Rassen is an employee and co-owner of Aetion, Inc. Michael A. Fischer reports research grants to his institution from Otsuka Pharmaceutical and CVS-Caremark for research evaluating medication adherence. John D. Seeger is a paid consultant to Optum and WHISCON for unrelated projects. Jessica M. Franklin has received grant funding for unrelated work from Merck and has consulted with Aetion, Inc. Sebastian Schneeweiss is a consultant to WHISCON, LLC and to Aetion, Inc., a software manufacturer of which he also owns shares. He is Principal Investigator of investigator-initiated grants to the Brigham and Women’s Hospital from Novartis and Boehringer Ingelheim, unrelated to the topic of the study. Jun Liu and Niteesh K. Choudhry have no conflicts of interest that are directly relevant to the content of this study.

Ethics approval

This study was approved by the Brigham and Women’s Hospital Institutional Review Board.

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Gagne, J.J., Polinski, J.M., Rassen, J.A. et al. Selective Serotonin Reuptake Inhibitor Use and Perioperative Bleeding and Mortality in Patients Undergoing Coronary Artery Bypass Grafting: A Cohort Study. Drug Saf 38, 1075–1082 (2015). https://doi.org/10.1007/s40264-015-0328-2

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  • DOI: https://doi.org/10.1007/s40264-015-0328-2

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