Dear Dr. Roach: My second inguinal hernia surgery resulted in pain and heavy bleeding in my groin. I understand why I was prescribed acetaminophen, but I’m confused about ibuprofen. This is a blood thinner, but I don’t know if my blood needs to be thinned because I had a lot of blood in and around my groin. — Mi
Answer: There are two systems that cause blood to clot in the body: platelets and clotting factors. Reducing the effectiveness of either of these systems may reduce the likelihood of blood clots. Drugs that affect either system are sometimes called “blood thinners,” but they do not thin the blood at all.
Aspirin, clopidogrel, ticagrelor, and several others are antiplatelet drugs. Aspirin is still used by some people for pain and inflammation and to prevent heart attacks, but it is well known to increase the risk of bleeding, which in some cases is so severe that it cannot be taken. It will be. Nonsteroidal anti-inflammatory drugs like ibuprofen have a much less effect on platelets than aspirin, but should still be used with caution in people who have some problems with platelets or after surgery.
Anti-inflammatory drugs such as ibuprofen and naproxen (despite their beneficial effects on pain and inflammation) in people who still have exudate after surgery or who have severe post-operative bleeding (such as after brain surgery) You should probably refrain from using it. Until it is safe to restart. Another option is a special type of anti-inflammatory drug called a COX-2 inhibitor, such as celecoxib. It has anti-pain and anti-inflammatory properties, but has no effect on platelets.
Drugs that affect clotting factors, such as warfarin and apixaban, are also usually avoided before and after major surgery.
Dear Dr. Roach: I am a 76-year-old man with severe osteoarthritis in my left knee. Since I am bone to bone, I manage the pain with regular cortisone injections and daily nonsteroidal anti-inflammatory drugs (NSAIDs).
I recently read an article that cautioned against cortisone injections. They say that long-term use of cortisone injections can actually accelerate the worsening of symptoms and the need for total knee replacement surgery. Can we confirm this and see if alternative injections such as hyaluronic acid or prolotherapy have the same effect? – DA
Answer: We can definitely confirm that regular steroid injections damage the cartilage in your joints. Hyaluronic acid does not damage cartilage, but studies have shown only modest improvements compared to placebo injections. It’s also quite expensive, so I don’t recommend it.
Prolotherapy is the injection of a stimulant, such as glucose, into the joint. Although some studies have shown it to be effective, most authorities, including the American College of Rheumatology and the Arthritis Foundation, do not recommend its use. Still, this treatment carries few risks and may be considered when there are no better options.
It must be emphasized that administering injections to people who are expecting an effect increases the risk of a placebo effect. That’s why we need studies that compare potential treatments with injections of something inert, such as saline.
Further advice
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