Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) contain a boxed warning for use in coronary artery bypass graft (CABG) surgery due to increased risk of thrombotic events, but recent research has challenged the assumption that these risks are a class effect. One anecdotal indication for NSAIDs in CABG is reducing chest tube output. Objective: The primary objective of this retrospective study was to determine whether indomethacin was associated with reduced duration of chest tube insertion after CABG surgery, defined as total chest tube duration in controls versus duration of chest tube insertion after the first dose of indomethacin in the treatment group. Secondary objectives were comparisons of daily reductions in chest tube output volume, length of stay, and safety between groups. Methods: In this retrospective, single-center case-control review, adult patients who received indomethacin after CABG were matched 1:1 to control patients based on age, sex, concomitant valve surgery, and, when possible, diabetes status. Results: Thirty-two patients were included. The mean age was 56 years and 75% were men. The primary outcome measure was 94 hours among control patients and 82.8 hours among indomethacin patients (P = 0.041). Insignificant mean reductions in daily chest tube output were observed prior to and after indomethacin initiation (38.7 vs 87.7 mL/day, P > 0.05). Conclusion: In this small, single-center study, indomethacin appeared safe and possibly effective for reducing chest tube duration after CABG surgery. Future large, prospective, randomized studies should be conducted to confirm the results.
U.S. Food and Drug Administration. Analysis and recommendations for agency action regarding nonsteroidal anti-inflammatory drugs and cardiovascular risk. J Pain Palliat Care Pharmcother. 2005;19(4):83-97.
2.
BombardierCLaineLReicinA, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR study group. N Engl J Med. 2000;343(21):1520-1528.
3.
BresalierRSSandlerRSQuanH, et al. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med. 2005;352(11):1092-1102.
4.
SibbaldB.Rofecoxib (Vioxx) voluntarily withdrawn from market. CMAJ. 2004;171(9):1027-1028.
5.
KulikABykovKChoudhryNKBatemanBT.Non-steroidal anti-inflammatory drug administration after coronary artery bypass surgery: utilization persists despite the boxed warning. Pharmacoepidemiol Drug Saf. 2015;24(6):647-653.
6.
HowardMLWarhurstRDSheehanC.Safety of continuous infusion ketorolac in postoperative coronary artery bypass graft surgery patients. Pharmacy (Basel). 2016;4(3):22.
7.
Mirmohammad-SadeghiMEtesampourAGharipourM, et al. Early chest tube removal after coronary artery bypass graft surgery. North Am J Med Sci. 2009;1(7):333-337.
8.
BryanAJAngeliniGD.Postoperative drainage and pericardial effusion. Ann Thorac Surg. 1990;50(2):330.
9.
GereckogluHAydinNBDagdevirenB, et al. Effect of timing of chest tube removal on development of pericardial effusion following cardiac surgery. J Card Surg. 2003;18(3):217-224.
10.
FrenchDGDilenaMLaPlanteS, et al. Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology. J Thorac Dis. 2016:8(suppl 1): S3-S11.
11.
BellomoRRoncoCKellumJA, et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204.
12.
NussmeierNAWheltonAABrownMT, et al. Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery. N Engl J Med. 2005;352:1081-1091.
13.
HynninenMSChengDCHHossainI, et al. Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery. Can J Anesth. 2000;47(12):1182-1187.
14.
EngorenMCHabibRHZachariasA, et al. Postoperative analgesia with ketorolac is associated with decreased mortality after isolated coronary artery bypass graft surgery in patients already receiving aspirin: a propensity-matched study. J Cardiothorac Vasc Anesth. 2007;21(6):820-826.
15.
EngorenMHadawayJSchwannTAHabibRH.Ketorolac improves graft patency after coronary artery bypass grafting: a propensity-matched analysis. Ann Thorac Surg. 2001;92(2):603-609.
16.
OliveriLJerzewskiKKulikA.Black box warning: is ketorolac safe for use after cardiac surgery?J Cardiothorac Vasc Anesth. 2014;28(2):274-279.
17.
MeekILvan de LaarMAFJVonkemanHE.Non-steroidal anti-inflammatory drugs: an overview of cardiovascular risks. Pharmaceuticals. 2010;3(7):2146-2162.
