The online version of this article (doi:10.1186/s13058-017-0926-2) contains supplementary material, which is available to authorized users.
Several frequently used prescription drugs may affect bleeding risk. We investigated use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), selective serotonin reuptake inhibitors (SSRIs), and statins and risk of postoperative red blood cell transfusion in breast cancer patients.
Using Danish population-based registries, we identified a cohort of women who underwent surgery for primary breast cancer (n = 22,238) during 2005–2012 and ascertained their use of aspirin, NSAIDs, SSRIs, and statins. For each drug, patients were categorized as users if they filled ≥1 prescription in the 60 days prior to surgery. We calculated the 14-day risk of red blood cell transfusion and relative risks (RRs) with 95% confidence intervals (CIs), comparing users with nonusers for each drug and adjusting for age, cancer stage, and Charlson Comorbidity Index score.
In our cohort, 1385 (6.2%) women were aspirin users, 1794 (8.0%) were NSAID users, 1110 (4.9%) were SSRI users, and 2053 (9.1%) were statin users. The overall risk of red blood cell transfusion was 1.3%. The 14-day risk of RBC transfusion was 3.5% among aspirin users versus 1.1% among aspirin nonusers (adjusted RR = 1.9, 95% CI: 1.4–2.7), and 1.8% among SSRI users versus 1.2% among SSRI nonusers (adjusted RR = 1.2, 95% CI: 0.7–1.9). Red blood cell transfusion risk was increased among NSAID users, but not in a sensitivity analysis with a 30-day exposure window. Red blood cell transfusion risk was not increased among SSRI and statin users.
Primary breast cancer surgery confers a low risk of RBC transfusion. Still, use of aspirin and possibly NSAIDs, but not SSRIs and statins, is associated with increased red blood cell transfusion. This increased risk is not explained by differences in age, stage, or comorbidity level.
Additional file 1: Appendix. Diagnostic codes, drug list with ATC codes and surgery codes. (DOCX 16 kb)
Additional file 2: Supplementary Figure S1 and Supplementary Tables S1–S5. Figure S1. Flow diagram. Table S1. Specific comorbid conditions included in the Charlson Comorbidity Index, according to use of selected prescription drugs. Table S2. Risk and crude and adjusted odds ratios for blood transfusion within 7 days of surgery among 22,238 breast cancer patients, according to use of selected prescription drugs. Table S3. Risk and crude and adjusted odds ratios for postoperative blood transfusion within 14 days of surgery among 22,238 breast cancer patients, according to use of selected prescription drugs and with the exposure window defined as 1–30 days before surgery. Table S4. Risk and crude and adjusted odds ratios for postoperative blood transfusion within 14 days of surgery among 22,238 breast cancer patients, according to use of selected prescription drugs and adjusted for selected comorbidities (cardiac disease, chronic pulmonary disease, and diabetes). Table S5. Risk and crude and adjusted odds ratios for postoperative blood transfusion within 14 days of surgery among 21,578 breast cancer patients according to use of selected prescription drugs, with the exposure window defined as 1–30 days before surgery and after excluding patients with anemia [< 12 g/dL (7.4 mmol/L)]. (ZIP 346 kb)
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- Use of prescription drugs and risk of postoperative red blood cell transfusion in breast cancer patients: a Danish population-based cohort study
Anne Marie L. Thomsen
Alma B. Pedersen
Nickolaj R. Kristensen
Bjarne Kuno Møller
Peer M. Christiansen
- BioMed Central
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