Brief Communication: Duration of Platelet Dysfunction after a 7-Day Course of Ibuprofen

5 April 2005 | Volume 142 Issue 7 | Pages 506-509

Background: Despite a paucity of evidence, clinicians routinely advise that patients discontinue using nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, at least 1 week before most surgical procedures.

Objective: To define the duration of ibuprofen-induced platelet dysfunction.

Design: Prospective cohort study.

Setting: Denver/Aurora, Colorado.

Participants: 11 healthy adult volunteers.

Measurements: Individuals were tested at baseline and serially after completion of a 7-day course of ibuprofen (600 mg orally every 8 hours). The platelet function analyzer (PFA-100, Dade Behring, Newark, Delaware), a test that has replaced the bleeding time in many clinical settings, was used.

Results: All participants exhibited normal platelet function before starting ibuprofen. Platelet dysfunction was apparent after completion of the ibuprofen course in 7 of the 11 participants and normalized by 24 hours after the last ibuprofen dose.

Limitations: The sample size in this study was small, and no participants had a major illness. Correlation between PFA-100 results and clinical bleeding has not been established.

Conclusions: Platelet function seems to normalize within 24 hours after cessation of regular ibuprofen use in healthy individuals. Further studies are warranted to provide a rational basis for timing of NSAID withdrawal in a range of patients undergoing surgery.

Editors' Notes Context The recommendation that patients discontinue using nonsteroidal anti-inflammatory drugs at least 1 week before surgery is common but not evidence-based. Contribution This study evaluated platelet function in 11 healthy volunteers at baseline and 40 minutes, 8 hours, and 24 hours after the participants completed a 7-day course of 600 mg of ibuprofen every 8 hours. Platelet function was abnormal 40 minutes after the last dose of ibuprofen in 7 of the 11 patients and normal in all by 24 hours, suggesting that it may not be necessary to discontinue ibuprofen use until 24 hours before surgery. Cautions This study evaluated platelet function in healthy adults using a platelet function analyzer and did not examine clinical bleeding. –The Editors

 

Author and Article Information

From the Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado Health Sciences Center, Aurora, Colorado.

Acknowledgments: The authors thank Chris Bombardier for assistance in study coordination and Chris McKelvey and Sue Hurwitz for their technical expertise in performing the PFA-100 testing. They also thank William E. Hathaway, MD, and Philip Altus, MD, for valued commentary on the manuscript and the study participants for their contribution to this research.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Neil Goldenberg, MD, The Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado Health Sciences Center, PO Box 6507, Mail Stop F416, Aurora, CO 80045-0507; e-mail, neil.goldenberg{at}uchsc.edu.

Current Author Addresses: Dr. Goldenberg, Ms. Jacobson, and Dr. Manco-Johnson: Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado Health Sciences Center, PO Box 6507, Mail Stop F416, Aurora, CO 80045-0507.

Author Contributions: Conception and design: N.A. Goldenberg, L. Jacobson, M.J. Manco-Johnson.

Analysis and interpretation of the data: N.A. Goldenberg, L. Jacobson, M.J. Manco-Johnson.

Drafting of the article: N.A. Goldenberg, L. Jacobson.

Critical revision of the article for important intellectual content: N.A. Goldenberg, L. Jacobson, M.J. Manco-Johnson.

Final approval of the article: N.A. Goldenberg, L. Jacobson, M.J. Manco-Johnson.

Provision of study materials or patients: N.A. Goldenberg, M.J. Manco-Johnson.

Statistical expertise: N.A. Goldenberg.

Obtaining of funding: M.J. Manco-Johnson (local funding).

Administrative, technical, or logistic support: N.A. Goldenberg, L. Jacobson, M.J. Manco-Johnson.

Collection and assembly of data: N.A. Goldenberg, L. Jacobson.