Share This Article:

Can High Dose Metamizol Medication Contribute to Postsurgical Hemorrhage:A Case Report

Abstract Full-Text HTML XML Download Download as PDF (Size:856KB) PP. 53-58
DOI: 10.4236/ojmn.2015.52009    3,144 Downloads   3,712 Views   Citations

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.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Wildpaner, D. , Flueckiger, B. , Schmid, U. , Weishaupt, D. and Theiler, R. (2015) Can High Dose Metamizol Medication Contribute to Postsurgical Hemorrhage:A Case Report. Open Journal of Modern Neurosurgery, 5, 53-58. doi: 10.4236/ojmn.2015.52009.

References

[1] Theiler, R. and Dudler, J. (2013) Drug Therapy of Pain: Reason Overwhelmed by Emotion? Revue méDicale Suisse, 9, 1846-1853.
[2] Pierre, S.C., Schmidt, R., Brenneis, C., Michaelis, M., Geisslinger, G. and Scholich, K. (2007) Inhibition of Cyclooxygenases by Dipyrone. British Journal of Pharmacology, 151, 494-503.
http://dx.doi.org/10.1038/sj.bjp.0707239
[3] Hinz, B., Cheremina, O., Bachmakov, J., Renner, B., Zolk, O., Fromm, M.F. and Brune, K. (2007) Dipyrone Elicits Substantial Inhibition of Peripheral Cyclooxygenases in Humans: New Insights into the Pharmacology of an Old Analgesic. The FASEB Journal, 21, 2343-2351.
http://dx.doi.org/10.1096/fj.06-8061com
[4] Lampl, C. and Likar, R. (2014) Metamizole (Dipyrone): Mode of Action, Drug-Drug Interactions, and Risk of Agranulocytosis. Der Schmerz, 28, 584-590.
http://dx.doi.org/10.1007/s00482-014-1490-7
[5] Bozzo, J., Escolar, G., Hernández, M.R., Galán, A.M. and Ordinas, A. (2001) Prohemorrhagic Potential of Dipyrone, Ibuprofen, Ketorolac, and Aspirin: Mechanisms Associated with Blood Flow and Erythrocyte Deformability. Journal of Cardiovascular Pharmacology, 38, 183-190.
[6] Arbeitsgemeinsschaft der wissenschaftlichen, medizinischen Fachgesellschaften (2009) S3-Leitlinie: Prophylaxe der venosen Thromboembolie (VTE).
[7] Graff, J., Arabmotlagh, M., Cheung, R., Geisslinger, G. and Harder, S. (2007) Effects of Parecoxib and Dipyrone on Platelet Aggregation in Patients Undergoing meniscectomy: A Double-Blind, Randomized, Parallel-Group Study. Clinical Therapeutics, 29, 438-447.
http://dx.doi.org/10.1016/S0149-2918(07)80082-8
[8] Parkhutik, V., Lago, A., Tembl, J.I., Rubio, C., Fuset, M.P., Vallés, J., Santos, M.T. and Moscardo, A. (2012) Influence of COX-Inhibiting Analgesics on the Platelet Function of Patients with Subarachnoid Hemorrhage. Journal of Stroke & Cerebrovascular Disease, 21, 755-759.
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2011.04.002
[9] Lanas, A., Serrano, P., Bajador, E., Fuentes, J. and Sáinz, R. (2003) Risk of Upper Gastrointestinal Bleeding Associated with Non-Aspirin Cardiovascular Drugs, Analgesics and Nonsteroidal Anti-Inflammatory Drugs. European Journal of Gastroenterology & Hepatology, 15, 173-178.
http://dx.doi.org/10.1097/00042737-200302000-00011
[10] Reilly, I.A. and FitzGerald, G.A. (1987) Inhibition of Thromboxane Formation in Vivo and ex Vivo: Implications for Therapy with Platelet Inhibitory Drugs. Blood, 69, 180-186.
[11] Tugrul, S., Degirmenci, N., Eren, S.B., Dogan, R., Veyseller, B. and Ozturan, O. (2014) Analgesic Effect of Magnesium in Post-Tonsillectomy Patients: A Prospective Randomised Clinical Trial. European Archives of Oto-Rhino-La- ryngology, August 2014.
http://dx.doi.org/10.1007/s00405-014-3219-8
[12] Altman, R., Luciardi, H.L., Muntaner, J. and Herrera, R.N. (2004) The Antithrombotic Profile of Aspirin. Aspirin Resistance, or Simply Failure? Thrombosis Journal, 2, 1.
http://dx.doi.org/10.1186/1477-9560-2-1
[13] Hohlfeld, T., Zimmermann, N., Weber, A.-A., Jessen, G., Weber, H., Schror, K., Holtje, H.-D. and Ebel, R. (2008) Pyrazolinone Analgesics Prevent the Antiplatelet Effect of Aspirin and Preserve Human Platelet Thromboxane Synthesis. Journal of Thrombosis and Haemostasis, 6, 166-173.
http://dx.doi.org/10.1111/j.1538-7836.2007.02800.x
[14] Saxena, A., Balaramnavar, V.M., Hohlfeld, T. and Saxena, A.K. (2013) Drug/Drug Interaction of Common NSAIDs with Antiplatelet Effect of Aspirin in Human Platelets. European Journal of Pharmacology, 721, 215-224.
http://dx.doi.org/10.1016/j.ejphar.2013.09.032
[15] Anzellotti, P., Capone, M.L., Jeyam, A., Tacconelli, S., Bruno, A., Tontodonati, P., Di Francesco, L., Grossi, L., Renda, G., Merciaro, G., Di Gregorio, P., Price, T.S., Garcia Rodriguez, L.A. and Patrignani, P. (2011) Low-Dose Naproxen Interferes with the Antiplatelet Effects of Aspirin in Healthy Subjects: Recommendations to Minimize the Functional Consequences. Arthritis & Rheumatism, 63, 850-859.
http://dx.doi.org/10.1002/art.30175
[16] Papp, J., Sandor, B., Vamos, Z., Botor, D., Toth, A., Rabai, M., Kenyeres, P., Cseplo, P., Juricskay, I., Mezosi, E., Koller, A. and Toth, K. (2014) Antiplatelet Effect of Acetylsalicylic Acid, Metamizole and Their Combination—in Vitro and in Vivo Comparisons. Clinical Hemorheology Microcirculation, 56, 1-12.
[17] Oreskovic, Z., Bicanic, G., Hrabac, P., Tripkovic, B. and Delimar, D. (2014) Treatment of Postoperative Pain after Total Hip Arthroplasty: Comparison between Metamizol and Paracetamol as Adjunctive to Opioid Analgesics—Prospec- tive, Double-Blind, Randomised Study. Archives of Orthopaedic and Trauma Surgery, 134, 631-636.
http://dx.doi.org/10.1007/s00402-014-1979-7

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.