COX 2 selectivity of non-steroidal anti-inflammatory drugs and perioperative blood loss in hip surgery. A randomized comparison of indomethacin and meloxicam

Abstract

In this prospective randomized study we tested the hypothesis that use of more cyclo-oxygenase 2 (COX 2)-selective non-steroidal anti-inflammatory drugs (NSAIDs) can reduce perioperative blood loss compared with non-selective NSAIDs. Data from 200 patients who underwent total hip replacement were studied. Two NSAIDs were compared: indomethacin 50 mg (n = 82) and meloxicam 15 mg (n = 86). Both NSAIDs were given orally 1 h before surgery. The two groups were not different with respect to age, gender, ASA class or duration of surgery. When indomethacin was used preoperatively, intraoperative blood loss was 623 +/- 243 mL (mean +/- SD) and postoperative blood loss 410 +/- 340 mL. After meloxicam, these values were 524 +/- 304 mL and 358 +/- 272 mL, respectively. Total perioperative blood loss after meloxicam was 17% (P < 0.05) less than that observed after indomethacin. Perioperative blood loss after meloxicam is less than after indomethacin. These in vivo findings are consistent with in vitro results using selective COX 2 NSAIDs.