Intravenous Ketorolac Tromethamine Worsens Platelet Function During Knee Arthroscopy Under Spinal Anesthesia

Thwaites, Brian K.; Nigus, Daren B.; Bouska, Gregory W.; Mongan, Paul D.; Ayala, Eleanor F.; Merrill, Gerald A.

doi:10.1097/00132586-199704000-00001

Cited by 6 publications

(12 citation statements)

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“…Evaluations of platelet inhibition by ketorolac with viscoelastic methods such as TEG and TEG-PM have been reported in the literature. 3,24,28,29 These studies address the safety of ketorolac in patients at risk for bleeding in the perioperative period and demonstrate no appreciable increase in risk of bleeding or significant alteration in hemostatic function similar to other studies focused specifically on the safety of ketorolac in children after cardiac surgery. 2,30,31 Despite evidence of normal global platelet function by aggregation and normal general hemostatic function by bleeding time, Thwaites and colleagues demonstrated a near abolition of thromboxane production in the presence of ketorolac.…”

Section: Discussionmentioning

confidence: 78%

“…Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) commonly used for analgesia in children after cardiac, orthopedic, and other surgeries without evidence of increased bleeding complication despite its known antiplatelet properties. 1 -3 Children with acquired and congenital heart disease (CHD) are at risk for thrombotic complications after cardiac surgery 4 for which antiplatelet therapy with aspirin (ASA) is recommended. Aspirin is often empirically used, particularly after single ventricle palliation and mitral or aortic valve replacement, among other conditions.…”

Section: Introductionmentioning

confidence: 99%

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Antiplatelet Effect of Ketorolac in Children After Congenital Cardiac Surgery

Kim

Kaufman

Patel

et al. 2018

World J Pediatr Congenit Heart Surg

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Background: Ketorolac is used for pediatric analgesia after surgery despite its known platelet inhibition via the arachidonic acid (AA) pathway. The degree of platelet inhibitory effect after cardiac surgery is not well characterized. Thromboelastography with platelet mapping (TEG-PM) is emerging as a frequently used test to evaluate platelet inhibition via the AA pathway. Methods: Post hoc analysis of a data set collected in a prospective observational cohort study evaluating platelet inhibition in children after congenital heart surgery with cardiopulmonary bypass (CPB). Categorization into two groups: (1) received ketorolac and (2) did not receive ketorolac for analgesia after surgery. The TEG-PM was evaluated at two time points (prior to surgery and 12-48 hours after CPB). Results: Fifty-three children were studied; mean age was 6.6 (range: 0.07-16.7) years and 45% (n ¼ 24) were female. Participants were distributed into two groups by ketorolac use, 41 within the ketorolac group and 12 in the no ketorolac group. All 41 participants who received ketorolac had platelet inhibition and 11 (91.7%) of 12 participants who did not receive ketorolac had normal platelet function after surgery (P < .0001). There was no difference in patient characteristics or clinical data between the two groups. Conclusions: Ketorolac use in a cohort of children after congenital cardiac surgery was associated with platelet inhibition via the AA pathway when evaluated by TEG-PM.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Antiplatelet Effect of Ketorolac in Children After Congenital Cardiac Surgery

Kim

Kaufman

Patel

et al. 2018

World J Pediatr Congenit Heart Surg

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“…In several studies in healthy volunteers, therapeutic doses of ketorolac (0.4 mg/kg) caused a significant inhibition of epinephrine-, adenosine-, and collagen-induced platelet aggregation and also prolonged bleeding times. [27][28][29][30] Further, in studies evaluating the effect of ketorolac on platelet function in patients undergoing surgical procedures, some 31 but not all 32 studies found that intravenous ketorolac was associated with inhibition of platelet aggregation and prolonged bleeding time.…”

Section: Discussionmentioning

confidence: 99%

Platelet Function: Meloxicam Intravenous in Whole Blood Samples From Healthy Volunteers

Jahr

Searle

McCallum³

et al. 2020

Clinical Pharm in Drug Dev

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective treatments for pain but may induce bleeding events due to platelet dysfunction associated with inhibition of cyclooxygenase (COX)-1 impairing thromboxane production. An intravenous nanocrystal formulation of meloxicam, a COX-2 preferential nonsteroidal anti-inflammatory drug, is under development for the treatment of moderate to severe pain. This single-center ex vivo study evaluated the effect of meloxicam intravenous and ketorolac on platelet function in whole blood samples from healthy volunteers. Each whole blood sample was aliquoted to allow analysis using a platelet function analyzer under negative control (untreated), positive control (2 therapeutic ketorolac concentrations), and meloxicam intravenous (1 therapeutic, 3 supratherapeutic concentrations) using both collagen with epinephrine and collagen with adenosine diphosphate reagent cartridges. The platelet function analyzer determines closure time by simulating platelet adhesion and aggregation following vascular injury. The final analysis set included data from 8 subjects. The collagen with adenosine diphosphate analysis (sensitive to thrombocytopathies) showed no significant differences in closure time for meloxicam-or ketorolac-treated samples and untreated control. The collagen with epinephrine analysis (sensitive to aspirin-induced platelet abnormalities) produced no significant difference in closure time between any meloxicam concentration and untreated control. Ketorolac was associated with significantly longer closure times vs untreated control at both the 2.5-and 5-µg/mL concentrations (P = .003 and .0257, respectively) and vs meloxicam at several concentrations. Similar results were observed when all analyzed samples were included. Meloxicam intravenous had no significant effect on closure times at therapeutic or supratherapeutic concentrations in this ex vivo study.

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“…As with the majority of other NSAIDs, Toradol is associated with a reduction in platelet function and blood clotting 14,20,82,85,91. Toradol decreases platelet aggregation and thromboxane production 91. Because Toradol affects only platelet function, it does not change the prothrombin time, partial thromboplastin time, or platelet count 85.…”

Section: Toradolmentioning

confidence: 99%

“…The clinical relevance of the prolongation of bleeding times in unclear20,82,85,91 because it has not correlated with operative blood loss 53,88. The combination of Toradol with additional oral NSAIDs (either prescription or over-the-counter) has not been studied but has the potential to increase bleeding and renal complications 21.…”

Section: Toradolmentioning

confidence: 99%

Soft Tissue Injections in the Athlete

Nepple

Matava

2009

Sports Health: A Multidisciplinary Approach

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Background:Injections into or adjacent to soft tissue structures, including muscle, tendon, bursa, and fascia, for pain relief and an earlier return to play have become common in the field of sports medicine.Study Design:Clinical review.Results:Corticosteroids, local anesthetics, and ketorolac tromethamine (Toradol) are the most commonly used injectable agents in athletes. The use of these injectable agents have proven efficacy in some disorders, whereas the clinical benefit for others remain questionable. All soft tissue injections performed for pain control and/or an anti-inflammatory effect have potentially serious side effects, which must be considered, especially in the pregame setting.Conclusions:The primary concern regarding corticosteroid and local anesthetic injections is an increased risk of tendon rupture associated with the direct injection into the tendon. Intramuscular Toradol injections provide significant analgesia, as well as an anti-inflammatory effect via its inhibitory effect on the cyclooxygenase pathway. The risk of bleeding associated with Toradol use is recognized but not accurately quantified.

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Intravenous Ketorolac Tromethamine Worsens Platelet Function During Knee Arthroscopy Under Spinal Anesthesia

Cited by 6 publications

References 0 publications

Antiplatelet Effect of Ketorolac in Children After Congenital Cardiac Surgery

Antiplatelet Effect of Ketorolac in Children After Congenital Cardiac Surgery

Platelet Function: Meloxicam Intravenous in Whole Blood Samples From Healthy Volunteers

Soft Tissue Injections in the Athlete

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