Although the
postpericardiotomy syndrome is a common complication of cardiac operations, the most effective
drug regimen for the treatment of this condition has not been established. The present study was designed to evaluate the effectiveness of nonsteroidal antiinflammatory drugs (
NSAIDs) in the treatment of
postpericardiotomy syndrome, in a double-blind, placebo-controlled randomized trial with a 10-day course of
ibuprofen or
indomethacin. Of 1019 adult patients undergoing cardiac operations during a 14-month period, a diagnosis of
postpericardiotomy syndrome was made in 187, and 149 were enrolled in the study. Diagnosis was based on the presence of at least two of the following:
fever, anterior
chest pain, and friction rub.
Drug efficacy was defined as the resolution of at least two of these criteria within 48 hours of
drug initiation.
Ibuprofen and
indomethacin were 90.2% and 88.7% effective, respectively, and both were significantly more effective than placebo (62.5%, p = 0.003). The occurrence of side effects, including
nausea,
vomiting,
renal failure, and fluid retention, was low in all groups (13.1% for
ibuprofen, 16.1% for
indomethacin, and 16.7% for placebo [p = not significant). Length of
hospital stay, incidence of ischemic events, and accumulation of significant
pericardial effusions were similar in all groups. The results of this study demonstrate that both
ibuprofen and
indomethacin provide safe and effective symptomatic treatment for
postpericardiotomy syndrome.