Ketorolac Reduces ICU Stay and Bleeding in Aortic Dissection Patients, confirms study

Acute Type A aortic dissection (aTAAD) is a severe cardiovascular emergency involving disruption of the intimal layer of the aorta, with rapid hemodynamic decline and high mortality unless surgically treated. Laboratory studies have implied that nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac may retard the progression of aortic dissection, but such evidence in human beings has not been available. This randomized controlled trial sought to assess whether perioperative ketorolac administration would safely and effectively enhance outcomes in aTAAD patients, with particular emphasis on mortality, organ malperfusion, and other postoperative parameters.

The trial included 110 patients who were eligible out of a total of 179 patients undergoing aTAAD surgery. Patients were randomly assigned to receive ketorolac or a placebo (0.9% saline solution).

• Preoperative Dose: Given at least 2 hours prior to surgery — either 60 mg ketorolac intramuscularly or 2 ml saline.

• Postoperative Dose: Extended for 48 hours — 30 mg ketorolac intramuscularly or 1 ml saline, twice a day.

Patients were monitored closely, with the main endpoints being safety and efficacy, with an emphasis on mortality and organ malperfusion incidence. Secondary endpoints were drug-related adverse events, intraoperative bleeding, duration of ICU stay, and hospital cost. Of 110 randomly assigned patients, one from the ketorolac group withdrew due to erythroderma, resulting in 54 patients in the ketorolac group and 55 in the placebo group being available for final analysis.

Key Findings

Although the two groups were similar in terms of the main outcomes of mortality and organ malperfusion, several secondary benefits occurred in the ketorolac group:

Intraoperative bleeding:

• Ketorolac group: Median of 1.8 liters

• Placebo group: Median of 2.0 liters

• Statistical significance: P = 0.03

Duration of stay in the ICU:

• Ketorolac group: Median of 6.5 days

• Placebo group: Median of 8 days

• Statistical significance: P = 0.04

Hospital costs:

Total hospital costs:

• Ketorolac group: Median of ¥170,430

• Placebo group: Median of ¥187,730

• Statistical significance: P = 0.03

• No increase in drug-related adverse effects was significant, and the overall safety profile of ketorolac was acceptable throughout the perioperative period.

Short-term administration of ketorolac in acute Type A aortic dissection patients did not affect primary outcomes such as mortality and organ malperfusion, but it resulted in substantial decreases in intraoperative bleeding, ICU stay time, and hospitalization expense. These findings affirm the safety and peroperative potential of ketorolac in aTAAD treatment.

Reference:

Lv, ZK., Zhang, HT., Cai, XJ. et al. Ketorolac in the perioperative management of acute type A aortic dissection: a randomized double-blind placebo-controlled trial. BMC Med 23, 188 (2025). https://doi.org/10.1186/s12916-025-04021-1