This document was published more than 2 years ago. The nature of the evidence may have changed.
NSAIDs are a class of drugs that are anti-inflammatory, analgesic and antipyretic but which also leads to an increased risk of bleeding.
Can NSAIDs intake during stomach and bowel surgery lead to an increased risk of bleeding?
SBU’s Enquiry Service identified four systematic reviews and seven randomised controlled studies (RCT) which addressed the effect of NSAID on surgery-related bleeding compared to placebo or any other medication. The four systematic reviews identified included studies that examined surgery-related bleeding for a range of surgeries not restricted to gastrointestinal surgery. The seven RCTs identified examined the risks of gastrointestinal surgery-related bleeding, including gallbladder and gastrointestinal tumour removal.
The authors of the two identified systematic reviews that examine COX-2 selective inhibitors draw the conclusion that there is no difference in surgery-related bleeding risks for any of the examined treatments. The authors of the remaining two reviews draw the conclusions that NSAID can lead to a slightly increased risk for surgery-related bleeding.
The authors of the identified RCTs draw the conclusion that there are no meaningful differences in the tendency for bleeding, duration of bleeding, or blood loss in patients treated with NSAIDs compared to controls. One study found that ketorolac administered during the surgery increased the bleeding duration compared to placebo. All seven RCTs were double blinded, but included relatively few patients (n=16 to 60).
SBU’s Enquiry Service has not itself drawn any conclusions in this matter as no attempt has been made to assess the quality nor to appropriately weight and combine the conclusions.
We searched Embase, Medline, The Cochrane Library, various HTA-databases, as well as web sites of various Swedish government agencies in June 2015. The complete search strategy is presented in the section “Literature search.” In addition, the reference lists of relevant articles were screened and Scopus was used.
Only systematic reviews or RCT that presented the effects of NSAID treatment on gastrointestinal surgery-related bleeding were included in this answer. We excluded RCTs that evaluated bleeding associated with orthopaedic or gynaecological procedures as well as organ transplantation. We have also excluded treatments that combined NSAIDs with other medications, for example acetylsalicylic acid.
Identified abstracts and articles were largely read by only one person. No attempt has been made to judge the quality of the included articles. It is likely that some of the included articles are of a lower quality than SBU usually includes in their assessments.
The abstracts of all 1219 articles identified by the literature search were read. Of these, 33 were judged to be potentially relevant and read in full text. In total eleven articles, four systematic reviews and seven RCTs, met the inclusion criteria. See section “Included articles”.
SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.