8: Does ketorolac increase the risk of bleeding?

Depth of Anesthesia

We investigate the claim that administering ketorolac (Toradol) increases bleeding and should be avoided in surgeries for which there is concern for bleeding.

Claim 1. Administration of intraoperative ketorolac increases the bleeding time due to platelet inhibition

Claim 2. Increased bleeding time translates to higher rate of surgical bleeding

Claim 3. The magnitude of bleeding propensity attributable to ketorolac is clinically relevant

Our guest today is Dr. Jamie Sparling of the Critical Care Division of the Massachusetts General Hospital.

Full show notes available at depthofanesthesia.com.

Connect with us @DepthAnesthesia on Twitter or [e-mail].

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Music by Stephen Campbell, MD.

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References

Bailey R, Sinha C, Burgess LP. Ketorolac tromethamine and hemorrhage in tonsillectomy: A prospective, randomized, double-blind study. Laryngoscope 1997;107:166–169.

Cassinelli EH, Dean CL, Garcia RM, Furey CG, Bohlman HH. Ketorolac use for postoperative pain management fol- lowing lumbar decompression surgery: A prospective, ran- domized, double-blinded, placebo-controlled trial. Spine (Phila Pa 1976) 2008;33:1313–1317.

Gobble RM, Hoang HL, Kachniarz B, Orgill DP. Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials. Plastic and Reconstructive Surgery 2014; 133(3): 741-755

Singer AJ, Mynster CJ, McMahon BJ. The effect of IM ketoro- lac tromethamine on bleeding time: A prospective, interven- tional, controlled study. Am J Emerg Med. 2003;21:441–443.

Strom BL, Berlin JA, Kinman JL, et al. Parenteral ketoro- lac and risk of gastrointestinal and operative site bleed- ing: A postmarketing surveillance study. JAMA 1996;275: 376–382.

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