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The Journal of Bone and Joint Surgery 78:968 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.

Correspondence

Correspondence

R. M. Dodenhoff, M.B., B.S., F.R.C.S., Robert J. Fragen, M.D., S. David Stulberg, M.D., Richard Wixson, M.D., Silas Glisson, Ph.D. and Eleanor Librojo, R.N.

TO THE EDITOR:

I read with interest "Effect of Ketorolac Tromethamine on Bleeding and on Requirements for Analgesia after Total Knee Arthroplasty" (77-A: 998–1002, July 1995), by Fragen et al. This is a useful contribution to the literature, but I think that some points should be raised.

The benefits of parenteral administration of non-steroidal drugs for postoperative analgesia have been well shown before3, and indeed many patients are maintained preoperatively on a treatment regimen that incorporates oral administration of non-steroidal drugs. The use of these drugs in combination with low-molecular-weight heparin, as was done in the study by Fragen et al., has two potential hemorrhagic interactions: (1) prolonged bleeding time caused by a direct suppressive effect on platelet production of thromboxane A2 and other prostaglandin endoperoxides and (2) decreased renal excretion . . . [Full Text of this Article]


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