From the FDA Drug Label
Ketorolac tromethamine inhibits platelet function and is, therefore, contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis and those at high risk of bleeding The patient has a history of hemorrhagic stroke, which is a type of cerebrovascular bleeding.
- The use of ketorolac is contraindicated in this patient due to the increased risk of bleeding.
- Key points to consider:
- Cerebrovascular bleeding is a contraindication for ketorolac use.
- Hemorrhagic stroke is a type of cerebrovascular bleeding.
- Ketorolac inhibits platelet function, increasing the risk of bleeding. 1
From the Research
Ketorolac should be avoided in patients with a history of hemorrhagic stroke due to its significant bleeding risk. As a non-steroidal anti-inflammatory drug (NSAID), ketorolac inhibits platelet aggregation and can prolong bleeding time, which is particularly dangerous for someone with prior cerebral hemorrhage. The risk of recurrent bleeding is substantially increased when using this medication, as it impairs the body's normal clotting mechanisms through its inhibition of prostaglandin synthesis.
Key Points to Consider
- Alternative pain management options should be considered, such as acetaminophen (up to 3000 mg daily in divided doses), which does not affect platelet function 2.
- If stronger pain control is needed, certain opioids may be safer options when used appropriately.
- The bleeding risk with ketorolac is dose-dependent and increases with duration of use, but even short-term use poses significant concerns in patients with hemorrhagic stroke history, as supported by a study that found oral ketorolac was associated with a significantly higher risk of hemorrhagic stroke with an OR of 2.69 (1.56 to 4.66) 3.
- This contraindication is especially important as the risk of recurrent hemorrhagic stroke is highest within the first year after the initial event but remains elevated indefinitely.
Relevant Studies
- A study published in 2021 discussed the management of hemorrhagic stroke, emphasizing the importance of controlling extremely high blood pressure in the acute phase and rapid reversal of vitamin K antagonists 4.
- Another study from 2024 found that early celecoxib use is associated with decreased mortality in patients with spontaneous intracerebral hemorrhage, but this does not directly apply to the use of ketorolac in patients with a history of hemorrhagic stroke 5.
- A 2020 study identified predictors of hemorrhagic stroke in older persons taking nonsteroidal anti-inflammatory drugs, including age, gender, and presence of diabetes or cardiovascular disease 6.