Post-Operative Bleed Risks Associated with Perioperative Nonsteroidal Anti-Inflammatory Drugs: A Narrative Review

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used medications that function by inhibiting cyclooxygenase enzymes. Although they are highly effective in managing pain and inflammation, their potential for increasing bleeding risks continues to be a concern. Due to the increased risk for bleeding complications following surgical procedures, the safety of perioperative NSAIDs is debated. The primary objective of this article is to examine literature published in the past 10 years focused on post-operative bleeding risks associated with perioperative NSAID use. A systematic search was designed to include randomized controlled trials, systematic review meta-analyses, and retrospective or prospective reviews examining post-operative bleeding events associated with perioperative NSAID use in adults. Following the screening process and review, 11 articles were included. The reviewed literature primarily examines post-operative bleeding incidence, blood loss, hemoglobin decline, and the frequency of hematomas or hemorrhages. Overall, the evidence suggests that perioperative NSAIDs have minimal impact on post-operative bleeding risk. COX-2 selective NSAIDs may be a safer alternative to nonselective NSAIDs, with some studies indicating a lower risk of post-operative bleeding following their use. Ultimately, the decision to use NSAIDs in the perioperative period should be tailored to the specific surgical procedure and individual patient factors.