Selective Serotonin Reuptake Inhibitors, Venlafaxine and Duloxetine are Associated With in Hospital Morbidity but Not Bleeding or Late Mortality After Coronary Artery Bypass Graft Surgery

Background: No Australian study has reported the association between selective-serotonin reuptake inhibitor (SSRI) and serotonin noradrenaline reuptake inhibitor (SNRI) with coronary artery bypass graft (CABG) surgery morbidity and mortality.

Methods: 4136 patients underwent CABG surgery between January 1996 and December 2008 and 105 (2.5%) were SSRI/SNRI users. Bleeding events included platelet, fresh frozen plasma and packed red blood cell transfusion, reoper-ation for bleeding and gastrointestinal bleeding. In-hospital morbidity included renal failure, stroke, ventilation >24 h, deep sternal wound infection, reoperation (any cause), myocardial infarction and mortality.

Results: Median follow-up was 4.7 years (interquartile range, 2.3–7.9 years) and there were 727 deaths (17.6% of total). Use of SSRI/SNRI was associated with new requirement for renal dialysis (adjusted OR = 2.18; 95% CI, 1.06–4.45, p = .03) and ventilation >24 h (adjusted OR = 1.69; 95% CI, 1.03–2.78, p = .04). Neither SSRI/SNRI use nor SSRI/SNRI and con-comitant anti-platelet medication increased the odds for any bleeding events (all p > .20). No association was evident with all-cause mortality (adjusted hazard ratio = 1.60; 95% CI .59–4.35, p = .36), or cardiac mortality (adjusted hazard ratio = .31; 95% CI, .04–2.26, p = .25).

Conclusions: SSRI/SNRI users experienced an increased risk of renal dysfunction and prolonged ventilation, but not bleeding events or long-term mortality after CABG surgery.