Bleeding and NSAIDs
The paper by Fransen and colleagues is interesting. I note in the
results that the authors identify that there was 'a significantly
increased risk of major bleeding complications among those in the
ibuprofen group' during the admission period, though there was no
difference in use of blood products (autologous or non-autologous), or in
suction drain volumes or haemoglobin between the groups. This surely
waters down their argument of ibuprofen precipitating 'major bleeding'.
There was no difference in the rates of bleeding between the two
groups at the surgical site. It would be interesting to know more about
the episodes of melaena, 'haemorrhage' (of undisclosed nature) and of the
extent of haematuria and bleeding haemorrhoids. It would also be
interesting to know the numbers of patients taking warfarin or with
prosthetic valves in the two groups.
The numbers of bleeding events are small, and by ignoring just one
bleeding event in the ibuprofen group, statistical significance of 'major
bleeding’ is abolished to a P value of 0.1 (using a Chi Sqaure).
Ibuprofen is a very useful agent as an adjunct in pain management in
many groups of patients, especially in the perioperative, as are other
NSAIDs. Interestingly the authors make no mention of acute pain scores in
the perioperative period, or of use of opiates between groups, or of the
incidence of constipation or nausea and vomiting between groups.
I would sorry to see NSAIDs banned from the orthopaedic wards based
on this study, as I observe on a daily basis that they have clear
benefits, in the short term at least.
Fransen M, Anderson C, Douglas J, Macmahon S, Neal B, Norton R, et
al. Safety and efficacy of routine postoperative ibuprofen for pain and
disability related to ectopic bone formation after hip replacement surgery
(HIPAID): randomised controlled trial. BMJ 2006; 333: 519-21.
Competing interests: No competing interests