Effects of diclofenac in the prevention of pericardial effusion after coronary artery bypass surgery. A prospective, randomized study.
BACKGROUND
It is suggested that pericardial effusions after cardiac surgery can be managed with non-steroid anti-inflammatory drugs, but the efficacy of this therapy is not well established. This study was planned to evaluate the efficacy of the prophylactic use of diclofenac in the prevention of pericardial effusion after coronary artery bypass surgery.


METHODS
In a prospective, randomized study, diclofenac sodium 50 mg was administered orally every 8 hours to 22 patients in the postoperative period. The control group consisted of 19 patients who were not given postoperatively either steroids or non-steroid anti-inflammatory drugs.


RESULTS
Twelve patients of the diclofenac-treated group (54.5%) and 7 of the control group (36.8%) experienced supraventricular arrhythmias postoperatively. There was no statistically significant difference in the size of postoperative pericardial effusion as well as in the occurrence of pleural effusion in both groups. However, there was a higher rate of significant pericardial effusion (grade I-III) in the control group as compared with the diclofenac-treated group (52.6% vs 31.8%, p=ns). Based on chest X-ray findings, patients in the control group had higher incidence of pleural effusion either alone (42.1% vs 22.7%, p=ns) or combined with pericardial effusion (21.0% vs 13.6%, p=ns). Patients who received diclofenac had lower median C-reactive protein concentration (76.0+/-45.2 mg/L) than the patients of the control group (99.6+/-47.8 mg/L), (p=ns).


CONCLUSIONS
The results of the present study suggest that diclofenac, even if without a striking effect, may lessen the degree of inflammatory reaction after cardiac surgery and may be useful in the prevention and in the management of early pericardial effusion after cardiac surgery.
Department of Cardiothoracic and Vascular Surgery, Oulu University Hospital, Finland.
M
M
Niva
F
F
Biancari
J
J
Valkama
J
J
Juvonen
J
J
Satta
T
T
Juvonen
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D004008:Diclofenac / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac