Parenteral ketorolac and risk of myocardial infarction
Article first published online: 5 APR 2002
Copyright © 2002 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety
Volume 11, Issue 2, pages 113–119, March 2002
How to Cite
Kimmel, S. E., Berlin, J. A., Kinman, J. L., Hennessy, S., Feldman, H., Carson, J. L. and Strom, B. L. (2002), Parenteral ketorolac and risk of myocardial infarction. Pharmacoepidem. Drug Safe., 11: 113–119. doi: 10.1002/pds.670
- Issue published online: 5 APR 2002
- Article first published online: 5 APR 2002
- Manuscript Accepted: 29 AUG 2001
- Manuscript Revised: 9 AUG 2001
- Manuscript Received: 21 JUN 2001
- Syntex Development Research
- anti-inflammatory agents;
- myocardial infarction;
- platelet aggregation inhibitors;
- cohort studies
To examine the effects of ketorolac, a non-aspirin non-steroidal anti-inflammatory drug (NANSAID) with anti-platelet properties, on the risk of in-hospital myocardial infarction (MI).
A retrospective cohort study was performed among hospitalized patients given 10 219 courses of parenteral ketorolac and patients given 10 145 courses of parenteral opioids, without ketorolac, in 35 hospitals. Patients were matched by hospital, admitting service, and date of study drug initiation. Any MI documented in the chart that occurred during the drug course and up to 3 days after the last dose was recorded by trained abstractors.
MI occurred in 18 (0.2%) ketorolac and 45 (0.4%) opioid courses (odds ratio (OR) 0.40, 95% confidence interval (CI) 0.23–0.69). This negative association persisted in multivariable analysis adjusting for age, sex, history of diabetes mellitus or cardiovascular disease, and administration of antiplatelet agents (OR 0.42; 95% CI 0.24–0.73). The association also persisted in numerous analyses excluding patients who may have been treated with analgesics for ischemic pain, and when restricting events to those occurring while on the drug (OR 0.34; 95% CI 0.17–0.69).
These results are consistent with a protective effect of ketorolac against MI. Future research that implements uniform screening for and independent validation of MIs as well as eliminates possible confounding by indication is the next logical step in confirming these findings. Copyright © 2002 John Wiley & Sons, Ltd.