2111 Case Series: Potential Link between the use of Celecoxib and Postoperative Hemorrhage Following Gynecological Surgery

Abstract

Study Objective To report a potential link between the use of celecoxib and postoperative hemorrhage following gynecological surgery. Design Case Series. Setting Ambulatory Surgery Center. Patients or Participants Women >18 yrs old. Interventions Laparoscopic-assisted myomectomy. Measurements and Main Results After a general practice change from acetaminophen to celecoxib for perioperative pain, there was a significant increase in rate of postoperative hemorrhage. Six patients presented with signs of hemorrhage and acute anemia within 48 hours of surgery and were admitted to the hospital for hemoperitoneum and blood transfusions. Patients were prescribed the maximum recommended oral dose of 400 mg of celecoxib the day before surgery, and 200 mg daily on postoperative days 1-6. Patients were also given acetaminophen 1000 mg immediately before surgery, and oxycodone/acetaminophen 5/325 mg for postoperative pain. Intraoperative courses were unremarkable except for 2 cases in which extensive adhesiolysis between the uterus and sigmoid colon required repair of a serosal defect, and a rectal serosal defect in the other. Uterine artery occlusion via temporary tourniquet and permanent ligation were performed to control blood loss in all cases. Hemostasis was confirmed in all 6 cases at the end of the procedures, and patients were in stable condition at discharge. Conclusion Our experience echoes 1 other study on unexpected hemorrhage linked to celecoxib. As Stammschulte et al. (2014) noted, celecoxib and concomitant NSAIDs may lead to a relative overdose due to interactions or irregularities in the metabolism of the affected patients. Given the seriousness of the adverse events, caution is warranted when prescribing celecoxib for perioperative pain therapy. To report a potential link between the use of celecoxib and postoperative hemorrhage following gynecological surgery. Case Series. Ambulatory Surgery Center. Women >18 yrs old. Laparoscopic-assisted myomectomy. After a general practice change from acetaminophen to celecoxib for perioperative pain, there was a significant increase in rate of postoperative hemorrhage. Six patients presented with signs of hemorrhage and acute anemia within 48 hours of surgery and were admitted to the hospital for hemoperitoneum and blood transfusions. Patients were prescribed the maximum recommended oral dose of 400 mg of celecoxib the day before surgery, and 200 mg daily on postoperative days 1-6. Patients were also given acetaminophen 1000 mg immediately before surgery, and oxycodone/acetaminophen 5/325 mg for postoperative pain. Intraoperative courses were unremarkable except for 2 cases in which extensive adhesiolysis between the uterus and sigmoid colon required repair of a serosal defect, and a rectal serosal defect in the other. Uterine artery occlusion via temporary tourniquet and permanent ligation were performed to control blood loss in all cases. Hemostasis was confirmed in all 6 cases at the end of the procedures, and patients were in stable condition at discharge. Our experience echoes 1 other study on unexpected hemorrhage linked to celecoxib. As Stammschulte et al. (2014) noted, celecoxib and concomitant NSAIDs may lead to a relative overdose due to interactions or irregularities in the metabolism of the affected patients. Given the seriousness of the adverse events, caution is warranted when prescribing celecoxib for perioperative pain therapy.