Title
Author
DOI
Article Type
Special Issue
Volume
Issue
Non-steroidal anti-inflammatory drugs and postoperative atrial fibrillation in patients having non-cardiac surgery: a systematic review
1Postgraduate Study Program (MSc) “Resuscitation”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
2First Department of Neurology, Eginition University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
3Department of Anesthesiology, Agia Sophia Children’s Hospital, 11527 Athens, Greece
4School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus
5Department of Neonatology, “Aretaieio” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
6School of Health Sciences, University of West Attica, 12243 Athens, Greece
7Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104-5158, USA
8Outcomes Research Consortium, Cleveland, OH 44195, USA
DOI: 10.22514/sv.2024.106 Vol.20,Issue 9,September 2024 pp.16-23
Submitted: 19 January 2024 Accepted: 07 March 2024
Published: 08 September 2024
*Corresponding Author(s): Athanasios Chalkias E-mail: thanoschalkias@yahoo.gr
Increasing evidence suggests an association between non-steroidal anti-inflammatory drugs (NSAIDs) and atrial fibrillation in the general population. A systematic review was conducted to characterize the association of perioperative NSAIDs with atrial fibrillation after non-cardiac surgery (POAF). PubMed and Scopus were searched for relevant studies. We excluded review articles, case studies, articles not published in English, and animal studies. The primary objective was to investigate the relationship between the perioperative use of NSAIDs and POAF during the first 30 postoperative days (from the day of surgery), at hospital discharge, and at 30 and 90 days after hospital discharge. Four studies were identified, a pooled analysis of two randomized double-blind clinical trials and three observational studies. A post-hoc sensitivity analysis for acetylsalicylic acid (aspirin) vs. other NSAIDs revealed that the former seems to decrease the incidence of POAF although non-significantly (Relative Risk (RR) (95% Confidence Interval (CI)): 0.92 (0.81, 1.04); p = 0.165). After excluding acetylsalicylic acid from the analysis, NSAIDs were associated with an increased risk of POAF development (RR (95% CI): 1.15 (1.07, 1.23); p < 0.001). In conclusion, perioperative administration of non-aspirin NSAIDs may be associated with an increased risk of POAF development. Further studies investigating the role of NSAIDs and the potential protective role of aspirin in POAF are justified.
Non-steroidal antiinflammatory drugs; Perioperative; Atrial fibrillation; Surgery; Non-cardiac surgery
Nicoleta Ntalarizou,Nikolaos Papagiannakis,Eleni Laou,Konstantinos Ekmektzoglou,Nicoletta Iacovidou,Theodoros Xanthos,Athanasios Chalkias. Non-steroidal anti-inflammatory drugs and postoperative atrial fibrillation in patients having non-cardiac surgery: a systematic review. Signa Vitae. 2024. 20(9);16-23.
[1] Dobrev D, Aguilar M, Heijman J, Guichard J, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nature Reviews Cardiology. 2019; 16: 417–436.
[2] Toutouzas K, Drakopoulou M, Markou V, Stougianos P, Tsiamis E, Tousoulis D, et al. Increased coronary sinus blood temperature: correlation with systemic inflammation. European Journal of Clinical Investigation. 2006; 36: 218–223.
[3] Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al; American College of Cardiology; American Heart Association. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Journal of the American College of Cardiology. 2014; 64: e77–e137.
[4] Toutouzas K, Stougiannos P, Drakopoulou M, Mitropoulos J, Bosinakou E, Markou V, et al. Coronary sinus thermography in idiopathic dilated cardiomyopathy: correlation with systemic inflammation and left ventricular contractility. European Journal of Heart Failure. 2007; 9: 168–172.
[5] Stefanadis C, Tsiamis E, Vaina S, Toutouzas K, Boudoulas H, Gialafos J, et al. Temperature of blood in the coronary sinus and right atrium in patients with and without coronary artery disease. The American Journal of Cardiology. 2004; 93: 207–120.
[6] De Caterina R, Ruigómez A, Rodríguez LAG. Long-term use of anti-inflammatory drugs and risk of atrial fibrillation. Archives of Internal Medicine. 2010; 170: 1450–1455.
[7] Schmidt M, Christiansen CF, Mehnert F, Rothman KJ, Sorensen HT. Non-steroidal anti-inflammatory drug use and risk of atrial fibrillation or flutter: population based case-control study. BMJ. 2011; 343: d3450.
[8] Zhang J, Ding EL, Song Y. Adverse effects of cyclooxygenase 2 inhibitors on renal and arrhythmia events. JAMA. 2006; 296: 1619.
[9] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021. 372: n71.
[10] Gan TJ, Singla N, Daniels SE, Lacouture PG, Min LH, Reyes CRD, et al. Cardiovascular safety of hydroxypropyl-β-cyclodextrin–diclofenac in the management of acute postsurgical pain: a pooled analysis of 2 randomized, double-blind, placebo- and active comparator–controlled phase III clinical trials. Journal of Clinical Anesthesia. 2016; 31: 249–258.
[11] Butt JH, Olesen JB, Havers-Borgersen E, Gundlund A, Andersson C, Gislason GH, et al. Risk of thromboembolism associated with atrial fibrillation following noncardiac surgery. Journal of the American College of Cardiology. 2018; 72: 2027–2036.
[12] Stronati G, Mondelli C, Urbinati A, Ciliberti G, Barbarossa A, Compagnucci P, et al. Derivation and validation of a clinical score for predicting postoperative atrial fibrillation in noncardiac elective surgery (the HART Score). The American Journal of Cardiology. 2022; 170: 56–62.
[13] Amar D, Zhang H, Heerdt PM, Park B, Fleisher M, Thaler HT. Statin use is associated with a reduction in atrial fibrillation after noncardiac thoracic surgery independent of c-reactive protein. Chest. 2005; 128: 3421–3427.
[14] Aguilar M, Nattel S. Postoperative atrial fibrillation after noncardiac surgery: maybe not so benign after all. Canadian Journal of Cardiology. 2019; 35: 1423–1425.
[15] Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate enhanced recovery after surgery pathways. Canadian Journal of Anesthesia. 2015; 62: 203–218.
[16] Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques. JAMA Surgery. 2017; 152: 691.
[17] Chalkias A, Laou E, Kolonia K, Ragias D, Angelopoulou Z, Mitsiouli E, et al. Elevated preoperative supar is a strong and independent risk marker for postoperative complications in patients undergoing major noncardiac surgery (SPARSE) Surgery. 2022; 171: 1619–1625.
[18] Chalkias A, Papagiannakis N, Saugel B, Flick M, Kolonia K, Angelopoulou Z, et al. Association of preoperative basal inflammatory state, measured by plasma supar levels, with intraoperative sublingual microvascular perfusion in patients undergoing major non-cardiac surgery. Journal of Clinical Medicine. 2022; 11: 3326.
[19] Laou E, Papagiannakis N, Tsiaka A, Tsapournioti S, Chatzikallinikidis K, Mantzaflaras G, et al. Soluble urokinase receptor levels are not affected by the systemic inflammatory response to anesthesia and operative trauma. European Surgical Research. 2022; 63: 249–256.
[20] Bosch DJ, Nieuwenhuijs-Moeke GJ, van Meurs M, Abdulahad WH, Struys MMRF. Immune modulatory effects of nonsteroidal anti-inflammatory drugs in the perioperative period and their consequence on postoperative outcome. Anesthesiology. 2022; 136: 843–860.
[21] Warltier D, Marret E, Flahault A, Samama C, Bonnet F. Effects of postoperative, nonsteroidal, antiinflammatory drugs on bleeding risk after tonsillectomy meta-analysis of randomized, controlled trials. Anesthesiology. 2003; 98: 1497–1502.
[22] Gilron I, Milne B, Hong M, Warltier D. Cyclooxygenase-2 inhibitors in postoperative pain management. Anesthesiology. 2003; 99: 1198–1208.
[23] Nussmeier NA, Whelton AA, Brown MT, Langford RM, Hoeft A, Parlow JL, et al. Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery. New England Journal of Medicine. 2005; 352: 1081–1091.
[24] Doleman B, Leonardi-Bee J, Heinink TP, Boyd-Carson H, Carrick L, Mandalia R, et al. Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery. Cochrane Database of Systematic Reviews. 2021; 6: CD012978.
[25] Nomani H, Mohammadpour AH, Moallem SMH, Sahebkar A. Anti-inflammatory drugs in the prevention of post-operative atrial fibrillation: a literature review. Inflammopharmacology. 2020; 28: 111–129.
[26] Gottlieb S. Cardioprotective effects of aspirin compromised by other NSAIDs. BMJ. 2003; 327: 520.
[27] Catella-Lawson F, Reilly MP, Kapoor SC, Cucchiara AJ, DeMarco S, Tournier B, et al. Cyclooxygenase Inhibitors and the antiplatelet effects of aspirin. New England Journal of Medicine. 2001; 345: 1809–1817.
[28] Corman SL, Fedutes BA, Ansani NT. Impact of nonsteroidal antiinflammatory drugs on the cardioprotective effects of aspirin. Annals of Pharmacotherapy. 2005; 39: 1073–1079.
[29] Rao GH, Johnson GG, Reddy KR, White JG. Ibuprofen protects platelet cyclooxygenase from irreversible inhibition by aspirin. Arteriosclerosis. 1983; 3: 383–388.
[30] Capone ML, Sciulli MG, Tacconelli S, Grana M, Ricciotti E, Renda G, et al. Pharmacodynamic interaction of naproxen with low-dose aspirin in healthy subjects. Journal of the American College of Cardiology. 2005; 45: 1295–1301.
[31] MacDonald T, Wei L. Effect of ibuprofen on cardioprotective effect of aspirin. The Lancet. 2003; 361: 573–574.
[32] Gladding PA, Webster MWI, Farrell HB, Zeng ISL, Park R, Ruijne N. The antiplatelet effect of six non-steroidal anti-inflammatory drugs and their pharmacodynamic interaction with aspirin in healthy volunteers. The American Journal of Cardiology. 2008; 101: 1060–1063.
[33] Siontis KC, Gersh BJ, Weston SA, Jiang R, Kashou AH, Roger VL, et al. Association of new-onset atrial fibrillation after noncardiac surgery with subsequent stroke and transient ischemic attack. JAMA. 2020; 324: 871.
[34] Shiroshitatakeshita A, Brundel B, Lavoie J, Nattel S. Prednisone prevents atrial fibrillation promotion by atrial tachycardia remodeling in dogs. Cardiovascular Research. 2006; 69: 865–875.
[35] Krijthe BP, Heeringa J, Hofman A, Franco OH, Stricker BH. Non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation: a population-based follow-up study. BMJ Open. 2014; 4: e004059.
[36] Schjerning Olsen A, Fosbøl EL, Pallisgaard J, Lindhardsen J, Lock Hansen M, Køber L, et al. NSAIDs are associated with increased risk of atrial fibrillation in patients with prior myocardial infarction: a nationwide study. European Heart Journal - Cardiovascular Pharmacotherapy. 2015; 1: 107–114.
[37] Ruffin RT, Kluger J, Baker WL, Wills SM, Michael White C, Coleman CI. Association between perioperative NSAID use and post-cardiothoracic surgery atrial fibrillation, blood transfusions, and cardiovascular outcomes: a nested cohort study from the AF Suppression Trials (AFIST) I, II and III. Current Medical Research and Opinion. 2008; 24: 1131–1136.
[38] Cheruku KK, Ghani A, Ahmad F, Pappas P, Silverman PR, Zelinger A, et al. Efficacy of nonsteroidal anti‐inflammatory medications for prevention of atrial fibrillation following coronary artery bypass graft surgery. Preventive Cardiology. 2004; 7: 13–18.
[39] Horbach SJ, Lopes RD, Guaragna JCVDC, Martini F, Mehta RH, Petracco JB, et al. Naproxen as prophylaxis against atrial fibrillation after cardiac surgery: the nafarm randomized trial. The American Journal of Medicine. 2011; 124: 1036–1042.
[40] Chuang S, Hsu P, Lin F, Huang Y, Wang G, Chang W, et al. Association between nonsteroidal anti‐inflammatory drugs and atrial fibrillation among a middle‐aged population: a nationwide population‐based cohort. British Journal of Clinical Pharmacology. 2018; 84: 1290–1300.
[41] Chokesuwattanaskul R, Chiengthong K, Thongprayoon C, Lertjitbanjong P, Bathini T, Ungprasert P, et al. Nonsteroidal anti-inflammatory drugs and incidence of atrial fibrillation: a meta-analysis. QJM. 2020; 113: 79–85.
[42] Jarrar YB, Jarrar Q, abed A, Abu-Shalhoob M. Effects of nonsteroidal anti-inflammatory drugs on the expression of arachidonic acid-metabolizing Cyp450 genes in mouse hearts, kidneys and livers. Prostaglandins & Other Lipid Mediators. 2019; 141: 14–21.
[43] Akintoye E, Wu JY, Hou T, Song X, Yang J, Hammock B, et al. Effect of fish oil on monoepoxides derived from fatty acids during cardiac surgery. Journal of Lipid Research. 2016; 57: 492–498.
[44] Ghosh R, Alajbegovic A, Gomes AV. NSAIDs and cardiovascular diseases: role of reactive oxygen species. Oxidative Medicine and Cellular Longevity. 2015; 2015: 1–25.
[45] van den Hondel KE, Eijgelsheim M, Ruiter R, Witteman JCM, Hofman A, Stricker BHC. Effect of short-term NSAID use on echocardiographic parameters in elderly people: a population-based cohort study. Heart. 2011; 97: 540–543.
[46] Hui Y, Ricciotti E, Crichton I, Yu Z, Wang D, Stubbe J, et al. Targeted deletions of cyclooxygenase-2 and atherogenesis in mice. Circulation. 2010; 121: 2654–2660.
[47] Chang C, Cheng C, Yang T, Chen Y, Lin Y, Chen S, et al. Selective and non-selective non-steroidal anti-inflammatory drugs differentially regulate pulmonary vein and atrial arrhythmogenesis. International Journal of Cardiology. 2015; 184: 559–567.
[48] Soliman D, Wang L, Hamming KSC, Yang W, Fatehi M, Carter CC, et al. Late sodium current inhibition alone with ranolazine is sufficient to reduce ischemia- and cardiac glycoside-induced calcium overload and contractile dysfunction mediated by reverse-mode sodium/calcium exchange. Journal of Pharmacology and Experimental Therapeutics. 2012; 343: 325–332.
[49] Ashpole NM, Herren AW, Ginsburg KS, Brogan JD, Johnson DE, Cummins TR, et al. Ca2+/Calmodulin-dependent protein kinase ii (CaMKII) regulates cardiac sodium channel NaV1.5 gating by multiple phosphorylation sites. Journal of Biological Chemistry. 2012; 287: 19856–19869.
[50] Whelton A, White WB, Bello AE, Puma JA, Fort JG; Success-VII Investigators. Effects of celecoxib and rofecoxib on blood pressure and edema in patients > or = 65 years of age with systemic hypertension and osteoarthritis. The American Journal of Cardiology. 2002; 90: 959–963.
[51] Aw TJ, Haas SJ, Liew D, Krum H. Meta-analysis of cyclooxygenase-2 inhibitors and their effects on blood pressure. Archives of Internal Medicine. 2005; 165: 490–496.
[52] Cheng H, Harris R. Renal effects of non-steroidal anti-inflammatory drugs and selective cyclooxygenase-2 inhibitors. Current Pharmaceutical Design. 2005; 11: 1795–1804.
[53] Harris RC. COX-2 and the kidney. Journal of Cardiovascular Pharmacology. 2006; 47: S37–S42.
[54] Miller TE, Myles PS. Perioperative fluid therapy for major surgery. Anesthesiology. 2019; 130: 825–832.
[55] Laou E, Papagiannakis N, Ntalarizou N, Choratta T, Angelopoulou Z, Annousis K, et al. The relation of calculated plasma volume status to sublingual microcirculatory blood flow and organ injury. Journal of Personalized Medicine. 2023; 13: 1085.
[56] Malbrain MLNG, Langer T, Annane D, Gattinoni L, Elbers P, Hahn RG, et al. Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy (IFA). Ann Intensive Care. 2020; 10: 64.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 1.3 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.
Top