title: Ketorolac improves graft patency after coronary artery bypass grafting: a propensity-matched analysis.
abstract: BACKGROUND
  The use of ketorolac, a potent cyclooxygenase-1 inhibitor, for analgesia after cardiac operations has been limited by concerns of increased cardiovascular events. However, a recent study found that its use after coronary artery bypass grafting was associated with improved survival.
  
  
  METHODS
  This was a retrospective study of patients who received coronary arteriograms for symptoms suggestive of recurrent ischemic heart disease. Patients who received postoperative ketorolac were matched with nonusers by propensity scores. Graft occlusion rates were compared, and their association with ketorolac use was compared using Cox proportional hazard modeling.
  
  
  RESULTS
  Although the rate of graft occlusion was similar in the two groups, in 184 of the 303 propensity-matched patients (61%) who received ketorolac vs 202 of the 303 patients (67%) who did not (p=0.13), there was a longer time to angiographically proven occlusion in the patients who received ketorolac (2.80±2.19 vs 2.04±1.63 years; p<0.001). Cox modeling to control for the other variables and the longer time to angiography in the ketorolac group showed that ketorolac use was associated with nearly a halving of the hazard ratio (0.561; 95% confidence interval, 0.454 to 0.692; p<0.001) for any graft occlusion.
  
  
  CONCLUSIONS
  The use of ketorolac after coronary artery bypass grafting was associated with a lower rate of angiographically proven graft closure and suggests a mechanistic (improved graft patency) explanation for the previously reported survival benefit of ketorolac.
authors.affiliation: Department of Anesthesiology, Mercy St. Vincent Medical Center, Toledo, Ohio 43608, USA. engoren@pol.net
authors.forename: Milo
authors.initials: M
authors.lastname: Engoren
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hadaway
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schwann
authors.forename: Robert H
authors.initials: RH
authors.lastname: Habib
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D017023:Coronary Angiography / Q000187:drug effects*; D001026:Coronary Artery Bypass / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D007262:Infusions, Intravenous; D020910:Ketorolac / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D014654:Vascular Patency / Q000187:drug effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D020910:Ketorolac