mobic and Blood-Loss--Surgical

To help define the perioperative risk related to commonly used non-aspirin NSAIDs with whole blood platelet aggregometry.. Twelve healthy volunteers were recruited. Two cyclooxygenase (COX)-1 inhibitors (ibuprofen and naproxen) and two COX-2 inhibitors (meloxicam and celecoxib) were administered, and daily whole blood platelet aggregometry studies were obtained until studies showed no platelet inhibition. Aspirin was studied at the conclusion of the study.. Ibuprofen had no inhibitory effect on platelet aggregation in all women and no inhibitory effect in 83% of men at 24 hours. All platelet function had returned to normal at 48 hours. The inhibitory effect of naproxen on platelets was absent at 48 hours in 83% of the women and 50% of men. By 72 hours all platelet studies had returned to normal. Meloxicam and celecoxib did not cause any overall inhibitory effect on platelet aggregation.. Ibuprofen and naproxen have a mild inhibitory effect on platelet aggregation compared with aspirin and this effect is undetectable by 48 hours and 72 hours, respectively. Meloxicam and celecoxib show essentially no inhibitory effect on platelet aggregation. These findings suggest that there is little bleeding risk related to platelet aggregation at 24 hours in patients who take COX-2 inhibitors and at 72 hours for those who take COX-1 inhibitor medications.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Blood Loss, Surgical; Celecoxib; Cyclooxygenase Inhibitors; Female; Healthy Volunteers; Humans; Ibuprofen; Male; Meloxicam; Middle Aged; Naproxen; Perioperative Care; Platelet Aggregation; Pyrazoles; Sulfonamides; Thiazines; Thiazoles; Young Adult

In this prospective randomized study we tested the hypothesis that use of more cyclo-oxygenase 2 (COX 2)-selective non-steroidal anti-inflammatory drugs (NSAIDs) can reduce perioperative blood loss compared with non-selective NSAIDs.. Data from 200 patients who underwent total hip replacement were studied. Two NSAIDs were compared: indomethacin 50 mg (n = 82) and meloxicam 15 mg (n = 86). Both NSAIDs were given orally 1 h before surgery.. The two groups were not different with respect to age, gender, ASA class or duration of surgery. When indomethacin was used preoperatively, intraoperative blood loss was 623 +/- 243 mL (mean +/- SD) and postoperative blood loss 410 +/- 340 mL. After meloxicam, these values were 524 +/- 304 mL and 358 +/- 272 mL, respectively. Total perioperative blood loss after meloxicam was 17% (P < 0.05) less than that observed after indomethacin.. Perioperative blood loss after meloxicam is less than after indomethacin. These in vivo findings are consistent with in vitro results using selective COX 2 NSAIDs.

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Cyclooxygenase 2; Cyclooxygenase 2 Inhibitors; Cyclooxygenase Inhibitors; Female; Humans; Indomethacin; Isoenzymes; Male; Meloxicam; Membrane Proteins; Middle Aged; Pain Measurement; Pain, Postoperative; Perioperative Care; Prospective Studies; Prostaglandin-Endoperoxide Synthases; Thiazines; Thiazoles; Time Factors