Ibuprofen combined with low-molecular-weight heparin does not affect hemostasis system in patients undergoing colorectal cancer surgery

Potapov A.L.; Dorozhkin A.D.; Khudyakov P.A.

doi:https://doi.org/10.17116/anaesthesiology202601152

Potapov A.L.

Tsyb Radiology Research Center

ORCID: 0000-0003-3752-3107

Dorozhkin A.D.

Tsyb Radiology Research Center

ORCID: 0000-0001-9565-301X

Khudyakov P.A.

Tsyb Radiology Research Center

ORCID: 0000-0002-0272-4737

Ibuprofen combined with low-molecular-weight heparin does not affect hemostasis system in patients undergoing colorectal cancer surgery

Authors:

Potapov A.L., Dorozhkin A.D., Khudyakov P.A.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2026;(1): 52‑56

DOI: 10.17116/anaesthesiology202601152

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To cite this article:

Potapov AL, Dorozhkin AD, Khudyakov PA. Ibuprofen combined with low-molecular-weight heparin does not affect hemostasis system in patients undergoing colorectal cancer surgery. Russian Journal of Anesthesiology and Reanimatology. 2026;(1):52‑56. (In Russ.)
https://doi.org/10.17116/anaesthesiology202601152

Использование инфографики авторами научных работ

OBJECTIVE

To evaluate the effect of intravenous ibuprofen on hemostatic parameters in patients undergoing colorectal cancer (CRC) surgery and concomitant thromboprophylaxis with low-molecular-weight heparin (LMWH).

MATERIAL AND METHODS

An open randomized study was conducted. To prevent thrombosis, all patients received the first LMWH injection 12 hours before surgery. Paracetamol 1000 mg (group 1, n=34) or ibuprofen 400 mg (group 2, n=35) were administered intravenously 30 min before the end of surgery. On the first postoperative day, hemoglobin, platelet count, drainage output and thromboelastography parameters were measured.

RESULTS

No major bleedings were observed. Hemoglobin, platelet count and drainage output did not differ significantly between groups. Clot formation time was prolonged in the 1^st group to 1.4 (1.1—1.6) min compared to 1.1 (1.0—1.3) min in another group (p=0.04). Clot formation rate (angle A) was lower in group 1 — 69.5 (67.1—74.5) and 73.8° (71.7—75.2), respectively (p=0.002). Maximum amplitude was lower in group 1 (69.5 (67—71.7) compared to 72.4 (69.7—75.7) mm, p=0.01). Clot strength was also lower in group 1 (11.1 (9.7—12.6) vs. 13.1 (11.5—15.6) dyn/s, p=0.02). These changes indicate higher inhibition of platelet function in the paracetamol group compared to ibuprofen.

CONCLUSION

For patients undergoing CRC surgery and receiving LMWH for thromboprophylaxis, perioperative analgesia with ibuprofen is safe regarding hemorrhagic complications and impact on hemostatic system.

Keywords:

colorectal cancer

surgery

low-molecular-weight heparin

paracetamol

ibuprofen

hemostasis

Authors:

Potapov A.L.

Tsyb Radiology Research Center

ORCID: 0000-0003-3752-3107

Dorozhkin A.D.

Tsyb Radiology Research Center

ORCID: 0000-0001-9565-301X

Khudyakov P.A.

Tsyb Radiology Research Center

ORCID: 0000-0002-0272-4737

Received:

07.02.2025

Accepted:

02.09.2025

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References:

Zlokachestvenny`e novoobrazovaniya v Rossii v 2023 godu (zabolevaemost` i smertnost`). Pod red. Kaprina AD, Starinskogo VV, Shaxzadovoj AO. M.: MNIOI im. P.A. Gercena — filial FGBU «NMICz radiologii» Minzdrava Rossii; 2024. (In Russ.).
Somonova OV, Antuh EA, Vardanyan AV, Gromova EG, Dolgushin BI, Elizarova AL, Sakaeva DD, Selchuk VYu, Tryakin AA, Cherkasov VA. Thromboembolic complications. Zlokachestvenny`e opuxoli. 2023;13(3s2-2):167-178. (In Russ.). https://doi.org/10.18027/2224-5057-2023-13-3s2-2-167-178
Marcucci M, Etxeandia-Ikobaltzeta I, Yang S, Germini F, Gupta S, Agarwal A, Ventresca M, Tang S, Morgano GP, Wang M, Ahmed MM, Neumann I, Izcovich A, Criniti J, Popoff F, Devereaux PJ, Dahm P, Anderson D, Lavikainen LI, Tikkinen KAO, Guyatt GH, Schünemann HJ, Violette PD Benefits and harms of direct oral anticoagulation and low molecular weight heparin for thromboprophylaxis in patients undergoing non-cardiac surgery: systematic review and network meta-analysis of randomised trials. BMJ. 2022;376:e066785. https://doi.org/10.1136/bmj-2021-066785
Ovechkin AM, Bayalieva AZh, Ezhevskaya AA, Eremenko AA, Zabolotskij DV, Zabolotskikh IB, Karelov AE, Koryachkin VA, Spasova AP, Khoronenko VE, Uvarov DN, Ulrikh GE, Shadrin RV. Postoperative analgesia. Guidelines. Vestnik intensivnoj terapii im. A.I. Saltanova. 2019;4:9-33. (In Russ.). https://doi.org/10.21320/1818-474x-2019-4-9-33
Instrukciya po medicinskomu primeneniyu lekarstvennogo preparata Intrafen-GEN. Accessed December 17, 2025. (In Russ.). https://grls.minzdrav.gov.ru/
Chang RW, Tompkins DM, Cohn SM. Are NSAIDs Safe? Assessing the Risk-Benefit Profile of Nonsteroidal Anti-inflammatory Drug Use in Postoperative Pain Management. The American Surgeon. 2021;87(6):872-879. https://doi.org/10.1177/0003134820952834
Ovechkin AM, Politov ME, Sokologorsky SV. Ibuprofen for intravenous administration: new possibilities for the use of NSAIDs in postoperative pain management. Regionarnaya anesteziya i lechenie ostroj boli. 2022;16(2):91-102. (In Russ.). https://doi.org/10.17816/1993-6508-2022-16-1-91-102
Petrikov AS, Vavilova TV, Vardanyan AV, Zamyatin MN, Zolotukhin IA, Lobastov KV, Roitman EV, Seliverstov EI, Stoyko YuM, Suchkov IA. Primary prevention of venous thromboembolism with low molecular weight heparins in surgical patients — 2024: Council of Experts resolution. Faramkoe`konomika. Sovremennaya farmakoe`konomika i farmakoe`pidemiologiya. 2024;17(2):251-278. (In Russ.). https://doi.org/10.17749/2070-4909/farmakoekonomika.2024.250
Enikeeva DA, Bondarchuk NG. Mechanisms of action and comparative characteristics of anticoagulants. Éksperimentalnaya i klinicheskaya farmakologiya. 2021;84(5):32-42. (In Russ.). https://doi.org/10.30906/0869-2092-2021-84-5-32-42
Arantes FBB, Menezes FR, Franci A, Barbosa CJDG, Dalçoquio TF, Nakashima CAK, Baracioli LM, FurtadoRHM, Nomelini QSS, Ramires JAF, Filho RK, Nicolau J.C. Influence of Direct Thrombin Inhibitor and Low Molecular Weight Heparin on Platelet Function in Patients with Coronary Artery Disease: A Prospective Interventional Trial. Advances in Therapy. 2020;37(1):420-430. https://doi.org/10.1007/s12325-019-01153-8
Bulanov AYu. Tromboe`lastografiya v sovremennoj klinicheskoj praktike. Atlas TE`G. M.: N`yudiamed; 2015. (In Russ.).
Driver B, Marks DC, van der Wal DE. Not all (N)SAID and done: Effects of nonsteroidal anti-inflammatory drugs and paracetamol intake on platelets. Research and Practice in Thrombosis and Haemostasis. 2019;4(1):36-45. https://doi.org/10.1002/rth2.12283
Munsterhjelm E, Nina M Munsterhjelm NM, Niemi TT, Ylikorkala O, Neuvonen PJ, Rosenberg PH. Dose-dependent inhibition of platelet function by acetaminophen in healthy volunteers. Anesthesiology. 2005;103(4):712-717. https://doi.org/10.1097/00000542-200510000-00009
Lages B, Weiss HJ. Inhibition of human platelet function in vitro and ex vivo by acetaminophen. Thrombosis Research. 1989;53(6):603-613. https://doi.org/10.1016/0049-3848(89)90150-3
Levchenko OK, Shulutko EM, Gemjan EG, Gorodetsky VM. Thrombocytopenia and postoperative analgesia. Russian Journal of Anesthesiology and Reanimatology. 2014;59(5):27-32. (In Russ.).
Bongiovanni T, Lancaster E, Ledesma Y, Whitaker E, Steinman MA, Allen IE, Auerbach A, Elizabeth Wick E. Systematic Review and Meta-Analysis of the Association between Non-Steroidal Anti-Inflammatory Drugs and Operative Bleeding in the Perioperative Period. Journal of the American College of Surgeons. 2021;232(5):765-790.e1. https://doi.org/10.1016/j.jamcollsurg.2021.01.005