Several problems related to coagulation dysfunctions induced by selective serotonin reuptake inhibitors (SSRIs) were reported in literature, as serotonin is widely distributed in the human organism and it has significant contribution in various vascular and hematologic regulatory mechanisms. First, a systematic review has integrated main results from the field of SSRIs and anticoagulants pharmacologic interactions. Secondly, a retrospective analysis was performed, based on the medical charts of hospitalized patients diagnosed with SSRI-treated depressive disorders, who also received concomitant anticoagulant treatment with acenocoumarol. Platelet count, prothrombin time, activated partial thromboplastin time, and bleeding time were monitored during hospitalization and their values before and after SSRI initiation treatment were compared.
We aim to introduce a 2022 update on CHD (carcinoid heart disease) considering a multidisciplinary perspective. This is a narrative mini-review. We searched English, full-length papers (PubMed). Inclusion criteria: original articles regardless of the level of statistical significance. We identified 44 papers and manually selected those with CHD, as follows: 8 original studies, 1 case series (N=9 patients), 16 case reports (N=1 patient/paper), and a total of 1,030 patients on published studies. The most remarkable results are the longest period of enrolment of 3-4 decades; CHD ratio among carcinoid syndrome of 37%; 30-day mortality post-cardiac surgery of 12%; median survival in CHD from 1.3 to 3.9 years (more than 2 years if valve intervention is provided); most useful prognostic markers: 5HIIA, NT-pro-BNP, but, potentially, chromogranin A. The specific protective role of somatostatin analogs against developing CHD is yet to be determined. CHD in the absence of carcinoid syndrome/liver metastasis may be related to ovarian NEN (neuroendocrine neoplasia) with a better outcome if prompt intervention. Remarkably, 3 guidelines are released regarding CHD on behalf of ENETS (European Neuroendocrine Tumor Society), and ESC (European Society of Cardiology). CHD still represents a most challenging entity situated at the crossroads of surgery, cardiology, oncology, endocrinology, and gastroenterology.
