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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2002 August;43(4):449-53

language: English

Effects of diclofenac in the prevention of pericardial effusion after coronary artery bypass surgery. A pros-pective, randomized study

Niva M. 1, Biancari F. 1, Valkama J. 2, Juvonen J. 3, Satta J. 1, Juvonen T. 1

1 Department of Cardiothoracic and Vascular Surgery, Department of Surgery
2 Department of Medicine, Oulu University Hospital, Oulu
3 Department of Medicine, Kainuu Central Hospital Kajaani, Finland


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 arryth­mi­as 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.

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