To determine the rate of post–face-lift hematoma among users of serotonin reuptake inhibitors (SSRIs) vs non-SSRI users. Selective serotonin reuptake inhibitors have come under recent scrutiny because of possible bleeding risks. However, cessation of SSRIs carries inherent risks.
Methods
The medical charts for 250 consecutive patients who underwent a modified deep-plane face-lift and 13 patients who underwent neck-lift from January 2010 to May 2011 were reviewed for the incidence of postoperative hematoma. Patients' medical records were examined for medical comorbidities, coagulopathy, and medication list, with particular attention to any usage of SSRIs or serotonin norepinephrine reuptake inhibitors (SNRIs).
Results
Twenty-two percent of patients were taking SSRIs or SNRIs. We observed a total hematoma (major + minor) rate of 1.95% for non–SSRI/SNRI users vs 1.72% for SSRI/SNRI users. The minor hematoma rate was 1.95% among nonusers vs 0% for users. The major hematoma rate was 0% among nonusers vs 1.72% for users.
Conclusions
Usage of SSRIs was more common in this large series of face-lift patients than in the general population. In these patients, SSRIs in the perioperative period are found to be safe and did not seem to adversely affect outcome. We found no evidence to support discontinuing SSRIs perioperatively.
Harirchian and coauthors performed a study to determine the rate of post–face-lift hematoma among selective serotonin reuptake inhibitors (SSRIs) users vs non–SSRI users. To their knowledge this is the first study of its kind in patients undergoing facial plastic surgery.
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References
1.
ZoumalanR, RizkSS. Hematoma rates in drainless deep-plane face-lift surgery with and without the use of fibrin glue.. Arch Facial Plast Surg. 2008; 10(2):103–107 18347237
2.
KamerFM, SongAU. Hematoma formation in deep plane rhytidectomy.. Arch Facial Plast Surg. 2000; 2(4):240–242 11074716
3.
BakerDC, StefaniWA, ChiuES. Reducing the incidence of hematoma requiring surgical evacuation following male rhytidectomy: a 30-year review of 985 cases.. Plast Reconstr Surg. 2005; 116(7):1973–1985 16327611
4.
GroverR, JonesBM, WaterhouseN. The prevention of haematoma following rhytidectomy: a review of 1078 consecutive facelifts.. Br J Plast Surg. 2001; 54(6):481–486 11513508
5.
ReesTD, LeeYC, CoburnRJ. Expanding hematoma after rhytidectomy: a retrospective study.. Plast Reconstr Surg. 1973; 51(2):149–153 4683935
6.
BarkerDE. Prevention of bleeding following a rhytidectomy.. Plast Reconstr Surg. 1974; 54(6):651–653 4438465
7.
StraithRE, RajuDR, HippsCJ. The study of hematomas in 500 consecutive face lifts.. Plast Reconstr Surg. 1977; 59(5):694–698 850705
8.
LawsonW, NaiduRK. The male facelift: an analysis of 115 cases.. Arch Otolaryngol Head Neck Surg. 1993; 119(5):535–539 8484943
9.
ReesTD, BaroneCM, ValauriFA, GinsbergGD, NolanWBIII. Hematomas requiring surgical evacuation following face lift surgery.. Plast Reconstr Surg. 1994; 93(6):1185–1190 8171138
10.
PerkinsSW, WilliamsJD, MacdonaldK, RobinsonEB. Prevention of seromas and hematomas after face-lift surgery with the use of postoperative vacuum drains.. Arch Otolaryngol Head Neck Surg. 1997; 123(7):743–745 9236595
11.
JonesBM, GroverR, HamiltonS. The efficacy of surgical drainage in cervicofacial rhytidectomy: a prospective, randomized, controlled trial.. Plast Reconstr Surg. 2007; 120(1):263–270 17572574
12.
PorYC, ShiL, SamuelM, SongC, YeowVK. Use of tissue sealants in face-lifts: a meta-analysis.. Aesthetic Plast Surg. 2009; 33(3):336–339 19089492
13.
McCloskeyDJ, PostolacheTT, VittoneBJ, et al.. Selective serotonin reuptake inhibitors: measurement of effect on platelet function.. Transl Res. 2008; 151(3):168–172 18279816
14.
De ClerckF. The role of serotonin in thrombogenesis.. Clin Physiol Biochem. 1990; 8,(suppl 3):40–49 1966729
15.
MeijerWE, HeerdinkER, NolenWA, HeringsRMC, LeufkensHGM, EgbertsACG. Association of risk of abnormal bleeding with degree of serotonin reuptake inhibition by antidepressants.. Arch Intern Med. 2004; 164(21):2367–2370 15557417
16.
HergovichN, AignerM, EichlerHG, EntlicherJ, DruckerC, JilmaB. Paroxetine decreases platelet serotonin storage and platelet function in human beings.. Clin Pharmacol Ther. 2000; 68(4):435–442 11061584
17.
DallM, Schaffalitzky de MuckadellOB, LassenAT, HansenJM, HallasJ. An association between selective serotonin reuptake inhibitor use and serious upper gastrointestinal bleeding.. Clin Gastroenterol Hepatol. 2009; 7(12):1314–1321 19716436
18.
DaltonSO, JohansenC, MellemkjaerL, NørgårdB, SørensenHT, OlsenJH. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: a population-based cohort study.. Arch Intern Med. 2003; 163(1):59–64 12523917
SerebruanyVL. Selective serotonin reuptake inhibitors and increased bleeding risk: are we missing something?. Am J Med. 2006; 119(2):113–116 16443409
21.
YuanY, TsoiK, HuntRH. Selective serotonin reuptake inhibitors and risk of upper GI bleeding: confusion or confounding?. Am J Med. 2006; 119(9):719–727 16945603
22.
TargownikLE, BoltonJM, MetgeCJ, LeungS, SareenJ. Selective serotonin reuptake inhibitors are associated with a modest increase in the risk of upper gastrointestinal bleeding.. Am J Gastroenterol. 2009; 104(6):1475–1482 19491861
23.
KharofaJ, SekarP, HaverbuschM, et al.. Selective serotonin reuptake inhibitors and risk of hemorrhagic stroke.. Stroke. 2007; 38(11):3049–3051 17901378
24.
DouglasI, SmeethL, IrvineD. The use of antidepressants and the risk of haemorrhagic stroke: a nested case control study.. Br J Clin Pharmacol. 2011; 71(1):116–120 21143507
25.
SalkeldE, FerrisLE, JuurlinkDN. The risk of postpartum hemorrhage with selective serotonin reuptake inhibitors and other antidepressants.. J Clin Psychopharmacol. 2008; 28(2):230–234 18344737
26.
NapeñasJJ, HongCHL, KempterE, BrennanMT, FurneySL, LockhartPB. Selective serotonin reuptake inhibitors and oral bleeding complications after invasive dental treatment.. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112(4):463–467 21821439
27.
KimDH, DaskalakisC, WhellanDJ, et al.. Safety of selective serotonin reuptake inhibitor in adults undergoing coronary artery bypass grafting.. Am J Cardiol. 2009; 103(10):1391–1395 19427434
28.
XiongGL, JiangW, ClareRM, et al.. Safety of selective serotonin reuptake inhibitor use prior to coronary artery bypass grafting.. Clin Cardiol. 2010; 33(6):E94–98 20552618
29.
AndreasenJJ, RiisA, HjortdalVE, JørgensenJ, SørensenHT, JohnsenSP. Effect of selective serotonin reuptake inhibitors on requirement for allogeneic red blood cell transfusion following coronary artery bypass surgery.. Am J Cardiovasc Drugs. 2006; 6(4):243–250 16913825
30.
GärtnerR, Cronin-FentonD, HundborgH, et al.. Use of selective serotonin reuptake inhibitors and risk of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study.. BMC Surg. 2010; 10:3 20096133
31.
van HaelstIMM, EgbertsTCG, DoodemanHJ, et al.. Use of serotonergic antidepressants and bleeding risk in orthopedic patients.. Anesthesiology. 2010; 112(3):631–636 20179499
32.
ShimRS, BaltrusP, YeJ, RustG. Prevalence, treatment, and control of depressive symptoms in the United States: results from the National Health and Nutrition Examination Survey (NHANES), 2005-2008.. J Am Board Fam Med. 2011; 24(1):33–38 21209342
33.
ZajeckaJ, TracyKA, MitchellS. Discontinuation symptoms after treatment with serotonin reuptake inhibitors: a literature review.. J Clin Psychiatry. 1997; 58(7):291–297 9269249
SkopBP, BrownTM. Potential vascular and bleeding complications of treatment with selective serotonin reuptake inhibitors.. Psychosomatics. 1996; 37(1):12–16 8600488
38.
LiN, WallénNH, LadjevardiM, HjemdahlP. Effects of serotonin on platelet activation in whole blood.. Blood Coagul Fibrinolysis. 1997; 8(8):517–523 9491270
39.
HougardyDMC, EgbertsTCG, van der GraafF, BrenninkmeijerVJ, DerijksLJ. Serotonin transporter polymorphism and bleeding time during SSRI therapy.. Br J Clin Pharmacol. 2008; 65(5):761–766 18279474
40.
AhrensT, FrankhauserP, LederbogenF, DeuschleM. Effect of single-dose sertraline on the hypothalamus-pituitary-adrenal system, autonomic nervous system, and platelet function.. J Clin Psychopharmacol. 2007; 27(6):602–606 18004127
41.
CarvajalA, OrtegaS, Del OlmoL, et al.. Selective serotonin reuptake inhibitors and gastrointestinal bleeding: a case-control study.. PLoS One. 2011; 6(5):e19819 21625637
42.
BakS, TsiropoulosI, KjaersgaardJO, et al.. Selective serotonin reuptake inhibitors and the risk of stroke: a population-based case-control study.. Stroke. 2002; 33(6):1465–1473 12052976
43.
ValuckRJ, OrtonHD, LibbyAM. Antidepressant discontinuation and risk of suicide attempt: a retrospective, nested case-control study.. J Clin Psychiatry. 2009; 70(8):1069–1077 19758520
