Archives of Orthopaedic and Trauma Surgery - 2026-03-12 - Journal Article
Serotonergic antidepressants are associated with increased bleeding events within 30-days after total shoulder arthroplasty: a propensity-matched analysis of 54,291 patients.
Strony JT, Moyal AJ, Adelstein JM, Burkhart RJ, Imbrogno AM, Abid R, Gillespie RJ, Chen RE
Topics
Key Takeaway
Preoperative SSRI/SNRI use is associated with 2.55-fold increased odds of intraoperative transfusion and 2.78-fold increased odds of post-hemorrhagic anemia at 7 days after TSA, with risks normalizing by 3 months.
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Summary
This study asked whether preoperative SSRI/SNRI use increases bleeding complications after primary TSA (fracture excluded) using the TriNetX database with propensity matching on 14 variables including PT/PTT and platelet function. SSRI/SNRI users had significantly higher odds of post-hemorrhagic anemia and transfusion on the day of surgery, at 7 days, and at 30 days, but complication rates were equivalent between groups from 1 to 3 months postoperatively. No significant differences in hematoma, hemorrhage, or reoperation rates were detected at any time point.
Key Limitation
Administrative database design precludes capture of SSRI/SNRI dose, duration, or compliance, and cannot distinguish between agents with varying serotonin reuptake potency that may carry different bleeding risk profiles.
Original Abstract
INTRODUCTION
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are associated with bleeding events following orthopaedic surgery. However, their effect on total shoulder arthroplasty (TSA) outcomes is unknown.
METHODS
Patients undergoing primary anatomic or reverse TSA in the United States were identified in the TriNetX database using Current Procedural Terminology (CPT) and International Classification of Disease (ICD-10) codes. TSA for fracture was excluded. Two cohorts were created based on preoperative serotonergic antidepressant use. Cohorts were matched to 14 demographic, comorbidity, laboratory and medication parameters. Outcomes were analyzed at one week, one month and three months postoperatively. Significance was set at p < 0.05.
RESULTS
7,374 matched patients were included per cohort. The SSRI/SNRI cohort had significantly higher odds for post-hemorrhagic anemia and transfusion on the day of surgery (Anemia - OR 1.50, 95%CI 1.28–1.76; Transfusion - OR 2.55, 95%CI 1.27–5.13), at seven-days post-op (Anemia - OR 2.78, 95%CI 1.68–4.58; Transfusion - OR 2.58, 95%CI 1.39–4.79) and at one month post-op (Anemia - OR 2.73, 95%CI 1.37–5.46; Transfusion - OR 2.31, 95%CI 1.09–4.88). From one through three-months post-operatively, the two cohorts did not differ in rates of postoperative anemia, hematoma/hemorrhage, or reoperation.
CONCLUSIONS
Serotonergic antidepressants were associated with a higher rate of bleeding events within 30 days postoperatively after TSA. These results are seen even when propensity matching for PT/PTT and platelet function. Complications normalize after 30 days and do not appear to pose a long-term risk.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s00402-026-06254-y.