Abstract
The use of metamizol significantly increased in the last decade, especially in non US countries [1]. Although metamizol is known to be a non selective COX inhibitor and therefore has platelet inhibiting potential, it is widely used in pain management in postsurgical setting. Methods: We present a case of bleeding after microsurgical decompression of a narrow lumbar spinal canal. Our patient developed a bleeding complication 3 days after the surgery. The bleeding spontaneously resolved after stopping the application of metamizol. Metamizol is a non selective COX inhibitor and is used as standard analgetic drug after surgery in our department, whereas other COX inhibitors are not. We made an intensive literature research to evaluate the prohaemorrhagic potential of metamizol. Metamizol has proven dose dependent platelet inhibiting effect. Conclusions: This is a quite ordinary case and there is no proof of metamizol being responsible for the bleeding in this case, it still poses questions at our daily routine and the question about a dose dependent clinically relevant prohaemorrhagic effect of metamizol remains unanswered. A proper study is needed.
Highlights
The more than 90-year-old drug metamizol, known as dipyrone, was taken from the market in many coun-How to cite this paper: Wildpaner, D., Flueckiger, B., Schmid, U.D., Weishaupt, D. and Theiler, R. (2015) Can High Dose Metamizol Medication Contribute to Postsurgical Hemorrhage: A Case Report
Metamizol is an antipyretic analgesic introduced into clinical practice in 1922
We browsed the medical records to find drugs with prohaemhorragic potential and found aspirin 100 mg per day, which was stopped 7 days prior the operation and metamizol, which she got in high doses as analgesic treatment
Summary
The more than 90-year-old drug metamizol, known as dipyrone, was taken from the market in many coun-. Especially in Europe and Latin America, it is still widely used as an analgesic and antipyretic drug and in some places it is even available over the counter without prescription [2]. The use of this drug has multiplied in the last years as it is assumed to be safe. The water-soluble pyrazolinone derivative is available in oral, rectal, and injectable forms It is rapidly hydrolyzed in the gastric juice to its main and active metabolite 4-methyl-amino-antipyrine [3]. In contrast to classical COX inhibitors metamizol is a stronger inhibitor of platelet aggregation [5], but has no anti-inflammatory effect and low gastrointestinal toxicity, indicating a different mode of action [2]
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