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Acute type A aortic dissection (aTAAD) is a fatal cardiovascular crisis that demands prompt attention.
In acute type A aortic dissection patients, intramuscular injection of ketorolac is beneficial to reduce bleeding, ICU stay, and hospital costs.
Acute type A aortic dissection (aTAAD) is a fatal cardiovascular crisis that demands prompt attention. Although preclinical studies in animals have depicted that ketorolac may help slow the progression of aortic aneurysms and dissections, there is limited clinical evidence supporting its usage in aTAAD patients. Hence, this randomized controlled trial sought to investigate the efficacy, safety, and therapeutic potential of ketorolac in individuals undergoing surgery for aTAAD.
Of the 179 patients undergoing aTAAD surgery, 110 fulfilled the inclusion criteria and were evenly randomized into ketorolac (n=55) and placebo (0.9% saline; n=55) groups. Therapy commenced at least 2 hours before surgery, with a single intramuscular injection of 60 mg ketorolac or 2 ml saline, and continued for 48 hours after surgery with intramuscular doses of 30 mg ketorolac or 1 ml saline given twice daily. The primary outcomes were mortality and organ malperfusion. Secondary outcomes encompassed adverse drug reactions, laboratory parameters, and other postoperative metrics.
Notably, 1 patient in the ketorolac arm discontinued the treatment due to postoperative erythroderma, resulting in 54 patients in that group being included in the final assessment. There were no prominent differences in the primary outcomes. However, patients receiving ketorolac experienced reduced intraoperative blood loss, shorter stays in the intensive care unit, and lower overall hospitalization expenses (Table 1).
Although short-term ketorolac use did not impact mortality and organ malperfusion, it was linked to benefits such as reduced blood loss during surgery, decreased ICU duration, and lower hospital costs. The findings support the safety and potential perioperative value of ketorolac for aTAAD care.
BMC Medicine
Ketorolac in the perioperative management of acute type A aortic dissection: a randomized double-blind placebo-controlled trial
Zhi-Kang Lv et al.
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