Perioperative Nonsteroidal Anti-Inflammatory Agents in the COVID-19 Orthopedic Patient
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RESPONSE TO COVID-19/REVIEW ARTICLE
Perioperative Nonsteroidal Anti-Inflammatory Agents in the COVID-19 Orthopedic Patient Christopher L. Wu, MD
& Kethy
M. Jules-Elysee, MD & Meghan A. Kirksey, MD, PhD & Gregory A. Liguori, MD
Received: 27 May 2020/Accepted: 23 July 2020/ * Hospital for Special Surgery 2020
Abstract Background: SARS-CoV-2 infection can cause serious complications beyond lung injury and respiratory failure, including sepsis, cardiovascular injury, renal failure, coagulation abnormalities, and neurologic injury. Widely used medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) have been flagged as having the potential to cause harm in the context of COVID-19. It is unknown if the benefits of NSAID use in the orthopedic population will outweigh the potential risks of increased morbidity in COVID-19 orthopedic patients. Methods: We conducted a narrative review of the use of NSAIDs in the orthopedic patient with COVID-19, focusing on the effects of NSAIDs on the inflammatory process, the role of NSAIDs in orthopedics, and the associations between NSAID use and complications of pneumonia. Results: We found that it may be appropriate to consider NSAID use in otherwise healthy orthopedic patients with COVID-19 and significant pain. Conclusions: In this context, we recommend that NSAIDs be used at the lowest effective dose for the shortest duration possible in orthopedic patients with COVID-19. However, pending further data and based on the concerns outlined in this review, we recommend avoiding NSAIDs in orthopedic patients with significant comorbidities and those who are undergoing major orthopedic surgery.
Keywords nonsteroidal anti-inflammatory agents . COVID-19 . orthopedic Introduction
As the coronavirus disease 2019 (COVID-19) pandemic unfolded, it became clear that SARS-CoV-2 infection can cause serious complications beyond lung injury and respiratory failure, including sepsis, cardiovascular injury, renal failure, coagulation abnormalities, and neurologic injury. Such complications may be particularly severe in elderly people and those with underlying health conditions [47]. One of the hallmarks of severe COVID-19 is the contribution of a dysfunctional immune response to disease progression as a result of an aggressive inflammatory response [38]. In the absence of an effective vaccine or treatment for COVID-19, many commonly available drugs have been examined for potential utility in managing this complicated disease. However, other widely used medications have been flagged as having the potential to cause harm in the context of COVID-19 [13]. In March 2020, the French Health Minister, Olivier Véran, claimed on Twitter that anti-inflammatory medications such as ibuprofen or cortisone might aggravate COVID-19, stimulating widespread global concern about these classes of otherwise useful drugs [43]. Approximately 1 in 15 adults in the USA use prescription Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-020-09783-3) contains suppl
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