No evidence from human studies has demonstrated that NRT increases the risk of healing-related or cardiovascular complications in the perioperative period. Nolan MB, Warner DO. Safety and Efficacy of Nicotine Replacement Therapy in the Perioperative Period: A Narrative Review. Mayo Clin Proc. 2015 Nov;90(11):1553-61.
NRT administration was not statistically different than non-administration for both ICU and hospital mortality. Gillies MA, McKenzie CA, Whiteley C, Beale RJ, Tibby SM.Safety of nicotine replacement therapy in critically ill smokers: a retrospective cohort study. Intensive Care Med. 2012 Oct;38(10):1683-8.
The use of NRT in a postoperative CABG surgery population resulted in a significant increase in mortality when adjusted for baseline characteristics. Paciullo CA, Short MR, Steinke DT, Jennings HR. Impact of nicotine replacement therapy on postoperative mortality following coronary artery bypass graft surgery. Ann Pharmacother. 2009 Jul;43(7):1197-202.
Patients with cardiovascular disease who continue to smoke have an increased risk of myocardial infarction, cerebrovascular accident, and other serious vascular events. Studies have indicated no increase in cardiovascular events in those who use NRT compared with those who continue to smoke. Ford CL, Zlabek JA. Nicotine replacement therapy and cardiovascular disease. Mayo Clin Proc. 2005 May;80(5):652-6.
Wound infections were significantly fewer in abstinent smokers compared with continuous smokers after 4, 8, and 12 weeks after randomization. No difference between transdermal nicotine patch and placebo was found. Sorensen LT, Karlsmark T, Gottrup F: Abstinence from smoking reduces incisional wound infection: A randomized controlled trial. Ann Surg 2003; 238:1–5
Few adverse cardiovascular events were reported, and no excess of these outcomes was detected among patients assigned to nicotine-patch use; nicotine-patch groups had increases in sleep disturbances, nausea or vomiting, localized skin irritation and respiratory symptoms, but the background rates and risk ratios varied considerably across studies. Greenland S, Satterfield MH, Lanes SF: A meta-analysis to assess the incidence of adverse effects associated with the transdermal nicotine patch. Drug Saf 1998; 18:297–308
Acute administration of transdermal nicotine did not decrease cutaneous perfusion; smoking cessation and transdermal nicotine normalized digital microvascular perfusion by 7 days. Fulcher SM, Koman LA, Smith BP, Holden M, Smith TL: The effect of transdermal nicotine on digital perfusion in reformed habitual smokers. J Hand Surg [Am] 1998; 23:792–9
High-dose nicotine treatment, even with concomitant smoking, caused no short-term adverse effects on the cardiovascular system. Zevin S, Jacob P III, Benowitz NL. Dose-related cardiovascular and endocrine effects of transdermal nicotine. Clin Pharmacol Ther. 1998 Jul;64(1):87-95.
The use of nicotine patches did not cause aggravation of myocardial ischemia or arrhythmia in coronary patients. Tzivoni D, Keren A, Meyler S, Khoury Z, Lerer T, Brunel P. Cardiovascular safety of transdermal nicotine patches in patients with coronary artery disease who try to quit smoking. Cardiovasc Drugs Ther. 1998 Jul;12(3):239-44.
Clinical trials of NRT in patients with stable coronary artery disease suggest that nicotine alone does not increase cardiovascular risk. Benowitz, NL, et al. Cardiovascular Toxicity of Nicotine: Implications for Nicotine Replacement Therapy. J Am Coll Cardiol. 1997;29(7):1422-1431
Oral and transdermal nicotine do not influence blood pressure or the hematology and coagulation indices measured in this study. Blann AD, Steele C, McCollum CN. The influence of smoking and of oral and transdermal nicotine on blood pressure, and haematology and coagulation indices. Thromb Haemost. 1997 Sep;78(3):1093-6.
Nicotine delivered by transdermal system is free of cardiac adverse effects in healthy volunteers. Khoury Z, Comans P, Keren A, Lerer T, Gavish A, Tzivoni D. Effects of transdermal nicotine patches on ambulatory ECG monitoring findings: a double-blind study in healthy smokers. Cardiovasc Drugs Ther. 1996 May;10(2):179-84.
Increases in the serum nicotine concentration do not cause a greater increase in myocardial oxygen demand and coronary arterial vasoconstriction when administered in current smokers. Keeley EC, Pirwitz MJ, Landau C, Lange RA, Hillis LD, Foerster EH, Conrad K, Willard JE. Intranasal nicotine spray does not augment the adverse effects of cigarette smoking on myocardial oxygen demand or coronary arterial dimensions. Am J Med 1996; 101:357–63
Transdermal nicotine does not cause a significant increase in cardiovascular events in high-risk outpatients with cardiac disease. Joseph AM, Norman SM, Ferry LH, Prochazka AV, Westman EC, Steele BG, Sherman SE, Cleveland M, Antonnucio DO, Hartman N, McGovern PG: The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease. N Engl J Med 1996; 335:1792–8