William Stokes1, Robert T Swanson2, Jane Schubart3,4, Michele M Carr1. 1. Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA. 2. College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA. 3. Department of Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA. 4. Department of Public Health Sciences, College of Medicine, Hershey, Pennsylvania State University, Pennsylvania, USA.
Abstract
OBJECTIVE: To better quantify the risk of ibuprofen-associated posttonsillectomy hemorrhage (PTH). DATA SOURCES: PUBMED/MEDLINE, Web of Science, and Cochrane Clinical Trials Database. REVIEW METHOD: Literature searches were performed for English-language publications containing the terms tonsillectomy, ibuprofen, and tonsillectomy from database inception to May 2017. Human clinical trials, prospective cohort studies, and retrospective cohort studies related to tonsillectomy, ibuprofen use, and posttonsillectomy hemorrhage among pediatric patients were selected. Electronic searches revealed 151 studies, of which 12 were deemed eligible for analysis. Studies were weighted according to level of evidence and risk of bias. RESULTS: Pooling of results across all studies showed a statistically significant increase in PTH among the patients taking ibuprofen (odds ratio, 1.38; 95% confidence interval, 1.11-1.72). The I 2 statistic of 20.8% demonstrates overall low study heterogeneity and good comparability of the results. CONCLUSION: Our meta-analysis of available cohort studies and randomized controlled trials (RCTs) shows possible increased tendency to PTH with the use of ibuprofen. This has not been demonstrated in other studies and systematic reviews because their analyses were limited by use of multiple nonsteroidal anti-inflammatory drugs and inclusion of studies limited to the perioperative period and low sample size. However, the current analysis is limited due to inclusion of many retrospective cohort studies with unclear follow-up and no blinding. Further RCTs will be required to investigate this trend toward increased PTH.
OBJECTIVE: To better quantify the risk of ibuprofen-associated posttonsillectomy hemorrhage (PTH). DATA SOURCES: PUBMED/MEDLINE, Web of Science, and Cochrane Clinical Trials Database. REVIEW METHOD: Literature searches were performed for English-language publications containing the terms tonsillectomy, ibuprofen, and tonsillectomy from database inception to May 2017. Human clinical trials, prospective cohort studies, and retrospective cohort studies related to tonsillectomy, ibuprofen use, and posttonsillectomy hemorrhage among pediatric patients were selected. Electronic searches revealed 151 studies, of which 12 were deemed eligible for analysis. Studies were weighted according to level of evidence and risk of bias. RESULTS: Pooling of results across all studies showed a statistically significant increase in PTH among the patients taking ibuprofen (odds ratio, 1.38; 95% confidence interval, 1.11-1.72). The I 2 statistic of 20.8% demonstrates overall low study heterogeneity and good comparability of the results. CONCLUSION: Our meta-analysis of available cohort studies and randomized controlled trials (RCTs) shows possible increased tendency to PTH with the use of ibuprofen. This has not been demonstrated in other studies and systematic reviews because their analyses were limited by use of multiple nonsteroidal anti-inflammatory drugs and inclusion of studies limited to the perioperative period and low sample size. However, the current analysis is limited due to inclusion of many retrospective cohort studies with unclear follow-up and no blinding. Further RCTs will be required to investigate this trend toward increased PTH.
Authors: Jakub Zieliński; Monika Morawska-Kochman; Krzysztof Dudek; Michał Czapla; Tomasz Zatoński Journal: J Clin Med Date: 2022-05-11 Impact factor: 4.964