Hello! Have read a lot on this forum (ty and also the fb group) and others that NSAIDs (other than aspirin) early in postop may increase risk for AF.
But wondering if there is guidance on the role of NSAIDs outside of the immediate postop period. Seems like sometimes they may be beneficial in helping decrease inflammation and swelling especially as one progresses in PT and loading the knee in rehab for flares for shorter bursts? But want sure if even these are harmful? And whether there is a maximum duration of number of days one should aim for NSAIDs if have to take them?
What is early postop defined as? First 6 weeks? Or longer?
Are certain NSAIDs less bad or less risky for AF progression or development? Several have mentioned Celebrex vs Naproxen/ibuprofen. is there literature or evidence as to how long a burst of NSAIDs could be safe or ok for AF?
From my reading here, seems like the risk of AF is continuous (for life?) and can happen late stage postop or even years later but that the risk of developing it is highest in the first 6-8 weeks? Postop? Is this the case? Or are there high risks anytime there is inflammation from exercise or rehab?
And is there any guidance on how long to stay on 81 mg aspirin postop as well?
Thanks so much and so grateful for this group!
Hi Rick,
Well-informed doctors no longer prescribe Celebrex in the long-term because it's known to significantly increase the risk of heart and kidney disease. Both diseases are forms of fibrosis, and long-term use of an NSAID (such as Celebrex) has also been shown to increase damage in knees (see Treatments, Oral Medications).
I can't give medical advice, but if I were you, I would ask my doctor about alternative medications to help sleep, such as low-dose, slow-release aspirin or paracetamol (acetaminophen). Melatonin could also help.
All the best,
Kayley
Hi,
I've had AF for 17 years now and take Celebrex daily, along with Gabapentin to help with sleep at night. What are your thoughts on this approach? From what I'm reading here and in the FB group, it may be causing more harm than good? Celebrex definitely causes some heartburn (I take Omeprazole for this).
Thanks!
Hi,
Thanks for your excellent questions, I'll respond as best I can, based on the scientific research. As you know, I'm not a clinician, and can't give advice, but I'll pass on what I understand.
Yes, research shows that NSAIDs and corticosteroids given immediately post-op increase the risk of chronic inflammation (long term inflammation), and they are generally looking at the first week after the surgery. It's thought that after this time, NSAIDs can be taken for a short time, but after 5 to 7 days taking them they increase inflammation rather than decreasing it. This is because NSAIDs prevent the production of the body's natural proteins that stop inflammation, but aspirin is good since it increases these anti-inflammatory processes.
So, if you want to use one of these non-aspirin NSAIDs, it's probably a good idea to take them for 5 to 7 days, then have a break. We don't know how long the break needs to be, perhaps a minimum is perhaps 2 days.
NSAIDs and pain control before PT is probably not wise, because pain is the way the body communicates that you've done too much, and you need to back off the activity on the affected limb. However, if you accidently overdid it, then a short time on an NSAID, or pain medication, might help.
The most important point here is to learn from the mistake, and try hard not to overdo it again! Knees sometimes only give a couple of warnings like this before the condition becomes permanent.
The only quality evidence I have seen regarding the type of NSAID that is best suited to fibrosis treatment is for aspirin. People with heart fibrosis often stay on low-dose aspirin for the rest of their life, if they tolerate it, but with arthrofibrosis you would aim to stop taking it when the condition resolves.
Arthrofibrosis in knees is typically the result of a bad injury or surgery, and if the knee is healing and progressing well at 8 weeks then it's unlikely that it would develop arthrofibrosis unless there was another serious injury or surgery. Each additional surgery increases the risk. A person can usually tell if the knee is not progressing well at 2 to 4 weeks post-op, and that's when modified PT etc should begin - the sooner, the better.
Hopefully with careful PT and anti-inflammatory approaches the knee will recover, but the first year post-op remains a delicate time when inflammation from aggressive exercise or even the flu can re-activate it. And it's much more difficult for the knee to recover if this happens.
If you have had, or have, arthrofibrosis in one knee then you're probably at increased risk of it in the other knee if it has surgery.
Kayley