Symptomatic treatment of dengue: Should the NSAID contraindication be reconsidered?

Symptomatic treatment of dengue: Should the NSAID contraindication be reconsidered? Postgrad Med. 2018 Dec 21;: Authors: Kellstein D, Fernandes L Abstract Consensus guidelines for treatment of dengue fever from the World Health Organization and US Centers for Disease Control recommend acetaminophen to manage pain and fever but contraindicate nonsteroidal anti-inflammatory agents (NSAIDs) because of potentially increased bleeding risk, with thrombocytopenia as a complication. Neither acetaminophen nor ibuprofen (the NSAID with lowest bleeding risk) have been evaluated for dengue treatment in randomized, controlled clinical trials. Epidemiologic and cohort studies and case series describing NSAID use in dengue generally point to minimal or no significant increase in bleeding risk, except for aspirin. Given the lack of data on use of NSAIDs in dengue, we assessed the literature for the risk of post-operative bleeding with NSAID use, with a particular focus on ibuprofen, as a potential surrogate marker of bleeding risk in dengue. Ibuprofen at over-the-counter doses used to treat pain and fever (i.e., up to 1,200 mg/d for up to 10 days) is associated with zero to minimally increased risk for post-operative bleeding events. Where detected, statistically significant increases in bleeding incidence and/or bleed volume were not clinically meaningful. Because hepatitis is also a frequent dengue complication, acetaminophen-associated hepatotoxi...
Source: Postgraduate Medicine - Category: Internal Medicine Tags: Postgrad Med Source Type: research