(1002) Safety of Intravenous Ketorolac Post-Coronary Artery Bypass Graft Surgery

Introduction: Following a randomized controlled trial demonstrating significant adverse CV events with the use of selective COX-2 inhibitors in patients undergoing Coronary Artery Bypass Graft (CABG) surgery, the FDA issued a boxed warning and contraindication for all NSAIDs use during CABG surgery. Nevertheless, IV ketorolac continues to be used for postoperative pain management post CABG. This study aimed to assess the safety of IV ketorolac for patients undergoing isolated CABG surgery and identify the characteristics of patients to whom it was administered.

Methods: This was an IRB approved, single-center, retrospective evaluation of patients who received IV ketorolac post CABG surgery. Subjects were identified via an adult isolated CABG surgery report from June 1, 2018 to June 30, 2023. Patients with ESRD, HF, hypercoagulopathic conditions, pregnant or incarcerated were excluded. The primary outcome was to evaluate rates of cardiovascular events including MI, ischemic strokes and thrombotic events such as DVT and PE. Secondary outcomes included bleeding rates, ICU and hospital lengths of stay, and inpatient mortality. Patient demographics, surgery characteristics, and ketorolac use was also collected. Data analysis was conducted using descriptive statistics.

Results: Sixty-one patients were screened for inclusion and 50 patients were included for analysis. The majority of patients were males with an average age of 62 years. The median baseline CrCl was 82.7 mL/min. Nine patients had a CrCl < 60 ml/min. 94% of patients were on concomitant aspirin and 77% of those were receiving aspirin plus another antiplatelet or anticoagulant. All patients received ketorolac at 15mg, with most patients prescribed PRN doses q6h, the median number of administrations was five. Two patients experienced a DVT and no patients developed a MI or ischemic stroke. Five patients had a Hgb decrease > 2g/dL. Of these, two patients received blood products and one had ketorolac discontinued. Three patients died in the hospital, none of which experienced bleeding or a DVT.

Conclusions: Ketorolac administered at doses of 15mg for post-operative pain control is safe in patients undergoing isolated CABG. The rates of bleeding, MI, ischemic strokes, DVT, PE, and in-patient mortality were less than those reported in previous literature.