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April 1997
Effect of ketorolac tromethamine on hemostasis.
Greer IA.
Pharmacotherapy 1990;10:71S-76S.
[ see abstract below ]
Ketorolac is known to have antiplatelet properties. This study assessed the effect of ketorolac on hemostasis compared with low-dose heparin, ketorolac-heparin combination and placebo. Heparin alone prolonged clotting time and anti-X3 levels, but had no effect on bleeding time or platelet function. Ketorolac had no effect on the above 2 parameters, but did prolong bleeding time about 33% [106 sec] as well as inhibited platelet aggregation. There was no interaction found between ketorolac and heparin. The authors conclude that the prolongation of bleeding time with ketorolac is modest and is unlikely to be of major clinical significance, since the values remained within the normal range in almost all subjects. Ketorolac should however be used with caution in persons with hemostatic disorders because of its antiplatelet properties.
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ABSTRACT
Ketorolac tromethamine is a potent synthetase inhibitor useful in the treatment of postoperative pain. Since it is also known to have antiplatelet properties, we determined its effect of ketorolac, alone and in combination with low-dose heparin, on hemostasis. Each of 12 healthy male volunteers received the following drug combinations on a double-blind, crossover basis: ketorolac dummy/heparin dummy, ketorolac active/heparin dummy, ketorolac active/heparin active, and ketorolac dummy/heparin active.
Ketorolac significantly prolonged bleeding time, and inhibited platelet aggregation and platelet thromboxane production. Heparin had no effect on bleeding time or platelet function, but significantly prolonged the kaolin-oephalin clotting time and increased anti-X3 levels. Ketorolac had no effect on the kaolin-oephalin clotting time or anti-X3 levels, and no interaction was found between ketorolac and heparin. The modest prolongation of bleeding time with ketorolac is unlikely to be of any major clinical significance, as the value remained within the normal range in almost all subjects. However, because of its antiplatelet properties, the drug should be used with caution in persons with hemostatic disorders.
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