Document Detail


Effects of perioperative antiinflammatory and immunomodulating therapy on surgical wound healing.
MedLine Citation:
PMID:  16232020     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with various rheumatologic and inflammatory disease states commonly require drugs known to decrease the inflammatory or autoimmune response for adequate control of their condition. Such drugs include nonsteroidal antiinflammatory drugs (NSAIDs), cyclooxygenase (COX)-2 inhibitors, corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologic response modifiers. These drugs affect inflammation and local immune responses, which are necessary for proper wound healing in the perioperative setting, thereby potentially resulting in undesirable postoperative complications. Such complications include wound dehiscence, infection, and impaired collagen synthesis. The end result is delayed healing of soft tissue and bone wounds. The current literature provides insight into the effect of some of these drugs on wound healing. For certain drugs, such as methotrexate, trials have been conducted in humans and direct us on what to do during the perioperative period. Whereas with other drugs, we must rely on either small-animal studies or extrapolation of data from human studies that did not specifically look at wound healing. Unfortunately, no clear consensus exists on the need and optimum time for withholding therapy before surgery. Likewise, clinicians are often uncertain of the appropriate time to resume therapy after the procedure. For those drugs with limited or no data in this setting, the use of pharmacokinetic properties and biologic effects of each drug should be considered individually. In some cases, discontinuation of therapy may be required up to 4 weeks before surgery because of the long half-lives of the drugs. In doing so, patients may experience an exacerbation or worsening of disease. Clinicians must carefully evaluate individual patient risk factors, disease severity, and the pharmacokinetics of available therapies when weighing the risks and benefits of discontinuing therapy in the perioperative setting.
Authors:
Anthony J Busti; Justin S Hooper; Christopher J Amaya; Salahuddin Kazi
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Pharmacotherapy     Volume:  25     ISSN:  0277-0008     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-10-19     Completed Date:  2006-02-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1566-91     Citation Subset:  IM    
Affiliation:
Texas Tech University Health Sciences Center School of Pharmacy, Dallas-Ft. Worth Regional Campus, Dallas, Texas 75216, USA. anthony.busti@ttuhsc.edu
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MeSH Terms
Descriptor/Qualifier:
Animals
Anti-Inflammatory Agents, Non-Steroidal / pharmacology*
Antirheumatic Agents / pharmacology
Arthritis, Rheumatoid / drug therapy
Crohn Disease / drug therapy
Cyclooxygenase Inhibitors / pharmacology
Fracture Healing / drug effects*,  physiology
Humans
Immunologic Factors / pharmacology*
Interleukin 1 Receptor Antagonist Protein
Orthopedic Procedures
Sialoglycoproteins / pharmacology
Surgical Procedures, Operative
Tumor Necrosis Factor-alpha / antagonists & inhibitors
Wound Healing / drug effects*,  physiology
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 0/Antirheumatic Agents; 0/Cyclooxygenase Inhibitors; 0/IL1RN protein, human; 0/Immunologic Factors; 0/Interleukin 1 Receptor Antagonist Protein; 0/Sialoglycoproteins; 0/Tumor Necrosis Factor-alpha

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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