What is the risk of bleeding with taking Celebrex (Celecoxib) after surgery?

From the Guidelines

Celebrex (celecoxib) should be avoided in the immediate post-operative period due to its increased risk of bleeding after surgery. The risk of bleeding with Celebrex is a significant concern, particularly in patients undergoing major surgeries, neurosurgery, or operations on highly vascular areas 1. As a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID), Celebrex inhibits prostaglandin production, which can interfere with blood clotting and wound healing.

Some key points to consider when assessing the risk of bleeding with Celebrex after surgery include:

• The overall morbidity and mortality data from NSAID-related GI bleeding, with 32,000 hospitalizations and 3,200 deaths annually in the United States 1
• The one-year risk of serious GI bleeding from chronic NSAID use, which ranges from one in 2,100 adults younger than 45 to one in 12,353 to one in 2,647 adults, respectively 1
• The increased risk of GI bleeding with concomitant use of anticoagulants, which can be five to six times that of persons using anticoagulants alone 1
• The risk of recurrent bleeding in persons with a history of ulcers, which can be as high as 5 percent in six months, even with use of COX-2 inhibitors or nonselective NSAIDs with a proton pump inhibitor 1

To minimize the risk of bleeding, most surgeons recommend stopping Celebrex at least 3-7 days before planned surgery and waiting until adequate healing has occurred before restarting it, typically 1-2 weeks after surgery depending on the procedure. If pain management is needed after surgery, acetaminophen (Tylenol) or short-term opioid medications are typically safer alternatives until your surgeon specifically clears you to resume Celebrex. Patients with additional risk factors for bleeding, such as those taking blood thinners, with liver disease, or with a history of stomach ulcers, should be especially cautious about using Celebrex after surgery.

From the FDA Drug Label

NSAIDs, including celecoxib capsules, may increase the risk of bleeding events. Co-morbid conditions such as coagulation disorders or concomitant use of warfarin, other anticoagulants, antiplatelet drugs (e.g., aspirin), SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) may increase this risk. Monitor these patients for signs of bleeding [see Drug Interactions (7)].

Celecoxib and anticoagulants such as warfarin have a synergistic effect on bleeding The concomitant use of Celecoxib and anticoagulants have an increased risk of serious bleeding compared to the use of either drug alone.

The risk of bleeding with taking Celebrex (Celecoxib) after surgery is increased, especially in patients with co-morbid conditions such as coagulation disorders or those taking concomitant medications like warfarin, aspirin, or SSRIs.

• Key factors that increase the risk of bleeding include:
  • Co-morbid conditions like coagulation disorders
  • Concomitant use of anticoagulants, antiplatelet drugs, or SSRIs
• Recommendation: Monitor patients for signs of bleeding, especially when using celecoxib after surgery 2, 2.

From the Research

Risk of Bleeding with Celebrex (Celecoxib) after Surgery

• The risk of bleeding with Celebrex (Celecoxib) after surgery is a concern, as it is a non-steroidal anti-inflammatory drug (NSAID) that can affect platelet function and increase the risk of bleeding 3.
• However, studies have shown that Celebrex (Celecoxib) does not significantly increase the risk of bleeding after surgery. A systematic review and meta-analysis of randomized controlled trials found that preoperative celecoxib did not increase intraoperative bleeding 4.
• Another study found that perioperative celecoxib administration for pain management after total knee arthroplasty did not increase the risks of bleeding, and there were no differences in blood loss (intra- and postoperative) between the groups 5.
• It is recommended to stop taking NSAIDs, including Celebrex (Celecoxib), before elective surgery to allow elimination of the drug and minimize the risk of bleeding complications 3.
• The timing of stopping NSAIDs before surgery varies, but it is generally recommended to stop them at least 1-10 days before surgery, depending on the specific medication and the patient's individual risk factors 6.

Specific Studies

• A study published in 2016 found that preoperative celecoxib in noncardiac surgery did not increase intraoperative bleeding, and actually decreased the risks of postoperative nausea and vomiting 4.
• A study published in 2008 found that perioperative celecoxib administration for pain management after total knee arthroplasty did not increase the risks of bleeding, and improved postoperative pain scores and opioid consumption 5.
• A study published in 1991 found that patients taking NSAIDs at hospital admission had more postoperative bleeding complications than those who were not taking these agents, and recommended stopping NSAIDs before elective surgery to minimize the risk of bleeding complications 3.
• A study published in 2008 found that perioperative versus postoperative celecoxib on patient outcomes after major plastic surgery procedures showed that celecoxib (400 mg p.o.) administered on the day of surgery and for 3 days postoperatively is effective in improving postoperative pain management, as well as the speed and quality of recovery after major plastic surgery, without increasing the risk of bleeding 7.