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Ketorolac use not linked with higher risk of hemorrhage in pediatric neurosurgery patients
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In this retrospective analysis, researchers found short-term ketorolac use does not lead to a significant increase in serious bleeding events as evidenced on imaging after pediatric neurosurgical procedures and can be considered as a perioperative regimen in this setting.
Researchers evaluated 1,451 neurological pediatric cases performed at a single institution. Primary outcomes included bleeding events that required a return to the OR, the development of renal failure, gastrointestinal tract injury or bleeding seen on postoperative imaging.
A total of 955 patients received ketorolac, and a multivariate regression analysis showed there was no significant association between clinically significant bleeding events or radiographic hemorrhaging and the perioperative use of ketorolac. Two patients developed gastrointestinal tract ulceration, and two patients experienced renal failures. All of these patients received ketorolac, but investigators noted this incidence was too small for statistical analysis.
A total of seven patients (0.5%) had significant bleeding events, but there was no statistically significant difference between patients who did or did not receive ketorolac and the development of significant bleeding, researchers reported. Four patients who received ketorolac developed bleeding events, while three patients who did not receive ketorolac developed bleeding events.
“While the presence of a pharmacological confounder was associated with a higher rate of hemorrhage in [the] bivariable analysis, the use of ketorolac in this context did not increase the risk for hemorrhage. Because of the small number of clinically significant postoperative hemorrhage events (n = 7), we were unable to perform [a] multivariable analysis,” researchers wrote in the study.
In all, 539 patients had axial imaging within a week of the procedure and 56 patients demonstrated postoperative hemorrhage. However, there was no significant difference in hemorrhaging events between those who received the NSAID and those who did not receive such treatment, the researchers noted. – by Robert Linnehan
Disclosure: The researchers report no relevant financial disclosures.
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