To the Editor We read with interest the article by Hakkarainen et al1 and wish to commend the authors on their attempt to shed light on the challenging question of nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk for anastomotic leakage after colorectal surgery. A growing body of evidence has implicated NSAIDs, particularly selective NSAIDs, as a risk factor for anastomotic leakage. These types of NSAIDs work by inhibiting the cyclooxygenase (COX) class of enzymes: COX1, which is present throughout the body (including the vascular endothelium, stomach, and kidneys) and COX2, which is predominantly found at the site of injury (triggered by inflammatory mediators).2
Saleh F, Okrainec A. Selective vs Nonselective Nonsteroidal Anti-inflammatory Drugs and Anastomotic Leakage After Colorectal Surgery. JAMA Surg. 2015;150(7):684–685. doi:10.1001/jamasurg.2015.0635
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