Ibuprofen combined with low-molecular-weight heparin does not affect hemostasis system in patients undergoing colorectal cancer surgery

Objective. To evaluate the effect of intravenous ibuprofen on hemostatic parameters in patients undergoing colorectal cancer (CRC) surgery and concomitant thromboprophylaxis with low-molecular-weight heparin (LMWH). Material and methods. An open randomized study was conducted. To prevent thrombosis, all patients received the first LMWH injection 12 hours before surgery. Paracetamol 1000 mg (group 1, n=34) or ibuprofen 400 mg (group 2, n=35) were administered intravenously 30 min before the end of surgery. On the first postoperative day, hemoglobin, platelet count, drainage output and thromboelastography parameters were measured. Results. No major bleedings were observed. Hemoglobin, platelet count and drainage output did not differ significantly between groups. Clot formation time was prolonged in the 1st group to 1.4 (1.1—1.6) min compared to 1.1 (1.0—1.3) min in another group (p=0.04). Clot formation rate (angle A) was lower in group 1 — 69.5 (67.1—74.5) and 73.8° (71.7—75.2), respectively (p=0.002). Maximum amplitude was lower in group 1 (69.5 (67—71.7) compared to 72.4 (69.7—75.7) mm, p=0.01). Clot strength was also lower in group 1 (11.1 (9.7—12.6) vs. 13.1 (11.5—15.6) dyn/s, p=0.02). These changes indicate higher inhibition of platelet function in the paracetamol group compared to ibuprofen. Conclusion. For patients undergoing CRC surgery and receiving LMWH for thromboprophylaxis, perioperative analgesia with ibuprofen is safe regarding hemorrhagic complications and impact on hemostatic system.