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Comment & Response |

Selective vs Nonselective Nonsteroidal Anti-inflammatory Drugs and Anastomotic Leakage After Colorectal Surgery

Fady Saleh, MD, MPH1; Allan Okrainec, MD, MHPE1
[+] Author Affiliations
1Division of General Surgery, University Health Network, Toronto, Ontario, Canada
JAMA Surg. 2015;150(7):684-685. doi:10.1001/jamasurg.2015.0635.
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To the Editor We read with interest the article by Hakkarainen et al1 and wish to commend the authors on their attempt to shed light on the challenging question of nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk for anastomotic leakage after colorectal surgery. A growing body of evidence has implicated NSAIDs, particularly selective NSAIDs, as a risk factor for anastomotic leakage. These types of NSAIDs work by inhibiting the cyclooxygenase (COX) class of enzymes: COX1, which is present throughout the body (including the vascular endothelium, stomach, and kidneys) and COX2, which is predominantly found at the site of injury (triggered by inflammatory mediators).2


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March 1, 2015
Timo W. Hakkarainen, MD, MS; Scott R. Steele, MD; Amir Bastaworous, MD, MBA; E. Patchen Dellinger, MD; Ellen Farrokhi, MD, MPH; Farhood Farjah, MD, MPH; Michael Florence, MD; Scott Helton, MD; Marc Horton, MD; Michael Pietro, MD; Thomas K. Varghese, MD; David R. Flum, MD, MPH
1Department of Surgery, University of Washington Medical Center, Seattle
2Department of Surgery, Madigan Army Medical Center, Ft Lewis, Washington
3Department of Surgery, Swedish Medical Center, Seattle, Washington
4Department of General and Vascular Surgery, Providence Medical Center, Everett, Washington
5Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
6Department of Surgery, St Joseph Medical Center, Bellingham, Washington
7Department of Surgery, Harborview Medical Center, Seattle, Washington
JAMA Surg. 2015;150(3):223-228. doi:10.1001/jamasurg.2014.2239.
July 1, 2015
Noel P. Lynch, MCh, MB, Med Sci; Emily Boyle, MD; Eamon G. Kavanagh, MD, FRCSI
1Department of Surgery, University Hospital Limerick, Limerick, Ireland
JAMA Surg. 2015;150(7):685. doi:10.1001/jamasurg.2015.0641.
July 1, 2015
Kevin Doody, BMBS; Margaret Coleman, FFARCSI, MSc, SEM
1Department of Anaesthesia, University Hospital Limerick, Limerick, Ireland
JAMA Surg. 2015;150(7):685-686. doi:10.1001/jamasurg.2015.0644.
July 1, 2015
Thomas M. Drake, BMedSci; Dmitri Nepogodiev, MBChB; Henry A. Claireaux, BSc(Hons)
1Student Audit and Research in Surgery (STARSurg) Steering Group, Birmingham, England
JAMA Surg. 2015;150(7):686. doi:10.1001/jamasurg.2015.0806.
July 1, 2015
Timo W. Hakkarainen, MD, MS; David R. Flum, MD, MPH
1Department of Surgery, University of Washington Medical Center, Seattle
JAMA Surg. 2015;150(7):686-687. doi:10.1001/jamasurg.2015.0638.
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