Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Plastic Surgery
Published in: European Journal of Plastic Surgery 5/2018

01-10-2018 | Original Paper

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

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

Published in: European Journal of Plastic Surgery | Issue 5/2018

Login to get access

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.
Literature
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):393–406CrossRef
2.
3.
4.
Lewis KG, Dufresne RG (2008) A meta-analysis of complications attributed to anticoagulation among patients following cutaneous surgery. Dermatol Surg 34(2):160–164CrossRef
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 33:155–159CrossRef
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):510–518CrossRef
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):68–77CrossRef
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):340–343CrossRef
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):76–78CrossRef
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):1225–1291CrossRef
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):e1000097CrossRef
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):1356–1360CrossRef
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):1237–1241CrossRef
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 384-5CrossRef
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):988–992CrossRef
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):584–591CrossRef
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):161–166CrossRef
18.
Shalom A, Wong L (2003) Outcome of aspirin use during excision of cutaneous lesions. Ann Plast Surg 50(3):296–298CrossRef
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):481–486CrossRef
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):466–472CrossRef
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):1360–1366CrossRef
22.
Bartlett GR (1999) Does aspirin affect the outcome of minor cutaneous surgery? Br J Plast Surg 52(3):214–216CrossRef
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):483–485CrossRef
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 998PubMed
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):278–286CrossRef
Metadata
Title
A systematic review of the risk of postoperative bleeding with perioperative non-steroidal anti-inflammatory drugs (NSAIDs) in plastic surgery
Authors
Murray Grant Forsyth
David J. Clarkson
Ciaran P. O’Boyle
Publication date
01-10-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Plastic Surgery / Issue 5/2018
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-018-1410-7

Other articles of this Issue 5/2018

European Journal of Plastic Surgery 5/2018 Go to the issue

Original Paper

Poly Implant Prothèse silicone breast implants: implant dynamics and capsular contracture

Original Paper

Split-thickness skin grafting using grafts of different thickness

Original Paper

The first step of patient-specific design calvarial implant: A quantitative analysis of fresh parietal bones

Original Article

Applications and limitations of using patient-specific 3D printed molds in autologous breast reconstruction

Master Class in Plastic Surgery

How to avoid common errors in writing scientific manuscripts

Original Paper

Reconstruction with artificial dermis of oncological surgical defects in the craniofacial district—Matriderm® versus Integra®: a non-randomized, unblinded single-operator case series