ATTUD Journal Club Postings

Nicotine Replacement Therapy

Oftentimes, surgeons recommend not using nicotine replacement therapies before or after surgery because nicotine is a vasoconstrictor; however, recent studies show that nicotine causes “angiogenesis;” i.e., increased new small arteries in tissue (that would help healing) that could outweigh the negative effects of vasoconstriction Two articles have reviewed this literature (Reuther and Brennan Br J Oral Maxillofacial Surgery ,e‐pub for 2013; Martin et al Experimental Dermatology 18: 497‐505). The second article reviews several studies and concludes “nicotine exposure enhances angiogenesis, but cannot compensate for the adverse effect of vasoconstriction.” The first review cites not only angiogenesis but improved clot formation from nicotine and suggests nicotine use may not be harmful.
In my reading of the literature, I note that the doses of nicotine being used to test these effects seem large compared to that from cigarettes. And I think both authors fail to recognize that nicotine from NRT occurs at such an even smaller dose. In addition, the articles fail to mention the risk of asking an exsmoker to stop NRT during a stressful period. I looked hard and could not find a true randomized trial of asking smokers to quit or cut down from smoking and in one group providing NRT to do so and in the other group, not doing so. My wager is that the former would do as well and, I think, in fact better than the latter group. If anyone has seen some good studies on this, let us know.