title: Perioperative blood loss and gastrointestinal tolerability of etoricoxib and diclofenac in total hip arthroplasty (ETO-DIC study): a single-center, prospective double-blinded randomized controlled trial.
abstract: OBJECTIVE
  Non-selective NSAIDs can cause serious gastrointestinal side-effects. Selective COX-2 blockers are a reasonable alternative for pain treatment. They do not seem to affect platelet function and consequently cause a lower perioperative blood loss than non-selective NSAIDs. This study compared etoricoxib and diclofenac during a perioperative (9 days) period after THA to investigate total blood loss and gastrointestinal tolerability. The hypothesis was that etoricoxib is superior to diclofenac.
  
  
  METHODS
  A total of 100 patients (50 in each group) were included in this trial. Etoricoxib (90 mg) was administered once and diclofenac sodium (75 mg) twice daily for 9 days. Total blood loss during and after primary cementless THA was detected. The rate of adverse events (AEs) and serious adverse events (SAEs) was analyzed to detect gastrointestinal tolerability.
  
  
  RESULTS
  The mean total blood loss (calculated) was 1548 ± SD 468 ml in the etoricoxib (ETO) group and 1649 (SD 547) ml in the diclofenac (DIC) group. The mean duration of THA was 81 min (SD 29) in the DIC and 75 min (SD 30) in the ETO group. Hence, the mean calculated total blood loss was 101 ml higher in the DIC group. This difference was not statistically significant (p = 0.334). Fifty-six patients (28 in each group) received a cell saver retransfusion, but only one patient (ETO group) needed an additional red blood cell transfusion. The hidden blood loss was 1067 ml (SD 603) in the DIC group and 999 ml (SD 378) in the ETO group. The gastrointestinal tolerability (number of adverse and serious adverse events) was not significantly different between groups.
  
  
  CONCLUSIONS
  There was no statistically significant difference in perioperative blood loss after primary THA under etoricoxib (90 mg) compared to diclofenac (75 mg). Furthermore, no gastrointestinal superiority of etoricoxib could be detected during a short period of 9 days.
authors.affiliation: a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany.
authors.forename: Sebastian H
authors.initials: SH
authors.lastname: Winkler
authors.affiliation: b b Münchner Studienzentrum, Klinikum rechts der Isar der Technischen Universität München , Munich , Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Barta
authors.affiliation: c c Institute for Medical Statistics and Epidemiology, Technische Universität , Munich , Germany.
authors.forename: Victoria
authors.initials: V
authors.lastname: Kehl
authors.affiliation: a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schröter
authors.affiliation: a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Wagner
authors.affiliation: a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Grifka
authors.affiliation: a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany.
authors.forename: Hans Robert
authors.initials: HR
authors.lastname: Springorum
authors.affiliation: a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Craiovan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D004008:Diclofenac / Q000009:adverse effects*; D004311:Double-Blind Method; D000077613:Etoricoxib; D005260:Female; D041981:Gastrointestinal Tract / Q000187:drug effects*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011725:Pyridines / Q000009:adverse effects*; D013450:Sulfones / Q000009:adverse effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D011725:Pyridines; D013450:Sulfones; D004008:Diclofenac; D000077613:Etoricoxib
keywords: Diclofenac; Etoricoxib; Perioperative blood loss; Total hip arthroplasty