Ketorolac may have a role in the perioperative management of aortic dissection

1. In this randomized clinical trial, the use of ketorolac in patients with Acute Type A Aortic Dissection (aTAAD), was not associated with a significant difference in efficacy or safety. However, it was associated with shorter stays in the intensive care unit (ICU), decreased bleeding intraoperatively, and potentially associated costs. 

Evidence Rating Level: 1 (Excellent) 

Acute Type A Aortic Dissection (aTAAD) is a life-threatening condition. With some severe conditions, surgery or medication can decrease mortality. However, previous research has shown that even with surgical intervention, the rate of mortality remains between 17-25%. As a result, the goal of this study is to investigate possible treatment options to develop a new treatment plan. Research suggests the Ras-related C3 botulinum toxin substrate 1 (RAC1) inhibitor R-ketorolac reduces the severity of aortic dissections in animal models. However, there is a lack of clinical evidence supporting its efficacy in aTAAD. To address this, the randomized clinical trial evaluated the safety and efficacy of ketorolac in patients with aTAAD. The study included 110 participants who were randomized 1:1 using block randomization to either receive ketorolac or the placebo. After one patient discontinued the ketorolac, there were 54 patients in the ketorolac group and 55 patients in the placebo group. After initially presenting to the hospital, each patient received fentanyl for pain management and underwent surgery within 24 hours of symptom presentation. After eligibility was met, 110 participants (mean age 50.7 ± 9.0 years, 78.0% male) were included. Compared to the placebo group, the ketorolac group experienced notably reduced intraoperative bleeding (median: 1.8L vs. 2.0L, P=0.003), shorter ICU stays (median: 8.0 days vs. 6.5 days, P=0.04), and lower total hospital costs (median: 170.43 x10³¥ vs 187.73 x 10³¥, P=0.03). During hospitalization, there were no significant differences in the blood test results between groups. However, on postoperative day 3, the levels of IL-1β (P<0.01) and IL-8 (P=0.03) were significantly lower in the ketorolac group compared to the placebo group. Overall, in this double-blind randomized clinical trial, treatment with ketorolac did not result in a difference in adverse safety effects or efficacy. However, it was associated with a shortened ICU stay, decreased intraoperative bleeding, and lower hospital costs proving to be of possible use in aortic surgery.

Click to read the study in BMC Medicine 

Image: PD

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