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A systematic review of the risk of postoperative bleeding with perioperative non-steroidal anti-inflammatory drugs (NSAIDs) in plastic surgery

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Abstract

Background

NSAIDs are used extensively in the perioperative period, for analgesia, or for preexisting conditions. However, potential risks of NSAID-induced haemorrhage have raised concerns regarding their use. NSAIDs inhibit platelet aggregation and have been shown to significantly increase bleeding time. In the available literature, there is an apparent lack of consensus regarding the use of NSAIDs and their clinical effects. A systematic review was undertaken to collate all relevant published data to provide a combined measure of the overall risk of serious complications when using NSAIDs in the perioperative period.

Methods

The search for potentially relevant studies was undertaken in PubMed for all publications up to August 2016, using appropriate medical subject (MeSH) headings. There were no restrictions on publication date or status. This was conducted in concordance with and adherence to the 2009 PRISMA guidance. Data harvested relevant papers was tabulated and analysed utilising Review Manager software to calculate a risk ratio (Mantel-Haenszel method, random effects).

Results

Twelve articles were included in the analysis, comprising 6581 patients, of which 1785 received an NSAID and 4796 were controls. Within the 1785 patients receiving NSAIDs, a total of 102 (5.7%) experienced moderate to severe complications, compared with 108 (2.2%) in the control groups.

Conclusions

Based on the assembled data, the authors conclude that the use of perioperative NSAIDs in plastic surgical procedures increases the risk of postoperative bleeding complications. Despite this, the rate of bleeding complications remains low.

Level of Evidence: Not ratable.

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References

  1. Michelet D, Andreu-Gallien J, Bensalah T, Hilly J, Wood C, Nivoche Y, Mantz J, Dahmani S (2012) A meta-analysis of the use of nonsteroidal antiinflammatory drugs for pediatric postoperative pain. Anesth Analg 114(2):393–406

    Article  CAS  Google Scholar 

  2. Cunningham AJ (1998) Anesthetic implications of laproscopic surgery. Yale J Biol Med 71(6):551–578

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Murphy DF (1993) NSAIDs and postoperative pain. BMJ 306(6891):1493–1494

    Article  CAS  Google Scholar 

  4. Lewis KG, Dufresne RG (2008) A meta-analysis of complications attributed to anticoagulation among patients following cutaneous surgery. Dermatol Surg 34(2):160–164

    Article  CAS  Google Scholar 

  5. Cronberg S, Wallmark E, Soderberg L (1984) Effect on platelet aggregation of oral administration of 10 non-steroidal analgesics to humans. Scand J Haematol 33:155–159

    Article  CAS  Google Scholar 

  6. Bauer KA, Gerson W, Wright C 4th, Wang J, McNicol E, Lanier RK, Kramer W, Carr DB (2010) Platelet function following administration of a novel formulation of intravenous diclofenac sodium versus active comparators: a randomized, single dose, crossover study in healthy male volunteers. J Clin Anesth 22(7):510–518

    Article  CAS  Google Scholar 

  7. Møiniche S, Rømsing J, Dahl JB, Tramèr MR (2003) Nonsteroidal anti-inflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg 96(1):68–77

    Article  Google Scholar 

  8. Dong YL, Fleming RY, Yan TZ, Herndon DN, Waymack JP (1993) Effect of ibuprofen on the inflammatory response to surgical wounds. JPJ Trauma 35(3):340–343

    Article  CAS  Google Scholar 

  9. Krischak GD, Augat P, Claes L, Kinzl L, Beck A (2007) The effects of non-steroidal anti-inflammatory drug application on incisional wound healing in rats. J Wound Care 16(2):76–78

    Article  CAS  Google Scholar 

  10. Emery P, Kong SX, Ehrich EW, Watson DJ, Towheed TE (2002) Dose-effect relationships of nonsteroidal anti-inflammatory effects: a literature review. Clin Ther 24(8):1225–1291

    Article  CAS  Google Scholar 

  11. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    Article  Google Scholar 

  12. Dixon AJ, Dixon MP, Dixon JB (2007) Bleeding complications in skin cancer surgery are associated with warfarin but not aspirin therapy. Br J Surg 94(11):1356–1360

    Article  CAS  Google Scholar 

  13. Dhiwakar M, Khan NA, McClymont LG (2006) Surgical resection of cutaneous head and neck lesions: does aspirin use increase hemorrhagic risk? Arch Otolaryngol Head Neck Surg 132(11):1237–1241

    Article  Google Scholar 

  14. Billingsley EM, Maloney EM (1997) Intraoperative and postoperative bleeding problems in patients taking warfarin, aspirin and nonsteroidal anti-inflammatory agents. A prospective study. Dermatol Surg 23(5):381–383 discussion 384-5

    Article  CAS  Google Scholar 

  15. Lawrence C, Sakuntabhai A, Tiling-Grosse S (1994) Effect of aspirin and nonsteroidal antiinflammatory drug therapy on bleeding complications in dermatologic surgical patients. J Am Acad Dermatol 31(6):988–992

    Article  CAS  Google Scholar 

  16. Cook-Norris RH, Michaels JD, Weaver AL, Phillips PK, Brewer JD, Roenigk RK, Otley CC (2011) Complications of cutaneous surgery in patients taking clopidogrel-containing anticoagulation. J Am Acad Dermatol 65(3):584–591

    Article  Google Scholar 

  17. Otley CC, Fewkes JL, Frank W, Olbricht SM (1996) Complications of cutaneous surgery in patients who are taking warfarin, aspirin, or nonsteroidal anti-inflammatory drugs. Arch Dermatol 132(2):161–166

    Article  CAS  Google Scholar 

  18. Shalom A, Wong L (2003) Outcome of aspirin use during excision of cutaneous lesions. Ann Plast Surg 50(3):296–298

    Article  Google Scholar 

  19. Grover R, Jones BM, Waterhouse N (2001) The prevention of haematoma following rhytidectomy: a review of 1078 consecutive facelifts. Br J Plast Surg 54(6):481–486

    Article  CAS  Google Scholar 

  20. Cawthorn TR, Phelan R, Davidson JS, Turner KE (2012) Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty. Can J Anaesth 59(5):466–472

    Article  Google Scholar 

  21. Legeby M, Sandelin K, Wickman M, Olofsson C (2005) Analgesic efficacy of diclofenac in combination with morphine and paracetamol after mastectomy and immediate breast reconstruction. Acta Anaesthesiol Scand 49(9):1360–1366

    Article  CAS  Google Scholar 

  22. Bartlett GR (1999) Does aspirin affect the outcome of minor cutaneous surgery? Br J Plast Surg 52(3):214–216

    Article  CAS  Google Scholar 

  23. Kargi E, Babuccu O, Hosnuter M, Babuccu B, Altinvazar C (2002) Complications of minor cutaneous surgery in patients under anticoagulant treatment. Aesthet Plast Surg 26(6):483–485

    Article  Google Scholar 

  24. Alam M, Goldberg LH (2002) Serious adverse vascular events associated with perioperative interruption of antiplatelet and anticoagulant therapy. Dermatol Surg 28:992–998 discussion 998

    PubMed  Google Scholar 

  25. Pieringer H, Stuby U, Biesenbach G (2007) Patients with rheumatoid arthritis undergoing surgery: how should we deal with antirheumatic treatment? Semin Arthritis Rheum 36(5):278–286

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Burns and Plastic Surgery, Nottingham City Hospital, Nottingham, NG5 1PB, UK

    Murray Grant Forsyth, David J. Clarkson & Ciaran P. O’Boyle

Authors
  1. Murray Grant Forsyth
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  2. David J. Clarkson
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  3. Ciaran P. O’Boyle
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Correspondence to Murray Grant Forsyth.

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Conflict of interest

Murray Grant Forsyth, David J. Clarkson and Ciaran P. O’Boyle declare that they have no conflict of interest.

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Ciaran O'Boyle additionally holds the position of Honorary Assistant Professor at the University of Nottingham.

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Forsyth, M.G., Clarkson, D.J. & O’Boyle, C.P. A systematic review of the risk of postoperative bleeding with perioperative non-steroidal anti-inflammatory drugs (NSAIDs) in plastic surgery. Eur J Plast Surg 41, 505–510 (2018). https://doi.org/10.1007/s00238-018-1410-7

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  • DOI: https://doi.org/10.1007/s00238-018-1410-7

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