title: Perioperative ketorolac increases post-tonsillectomy hemorrhage in adults but not children.
abstract: OBJECTIVE
  To evaluate the risk of post-tonsillectomy hemorrhage associated with perioperative ketorolac use.
  
  
  METHODS
  Systematic review and meta-analysis of primary articles reporting individual-level post-tonsillectomy hemorrhage rates in subjects receiving perioperative ketorolac and matched controls. Retrospective and prospective studies were both included.
  
  
  METHODS
  PubMed search was performed for "[ketorolac OR toradol] AND tonsillectomy." Articles fulfilling inclusion criteria were subjected to meta-analysis to determine summary relative risk (RR).
  
  
  RESULTS
  Adults are at five times increased risk for post-tonsillectomy hemorrhage with ketorolac use (RR: 5.64; 95% confidence interval [CI]: 2.08-15.27; P < .001). In contrast, children under 18 are not at statistically significantly increased risk (RR: 1.39; 95% CI: 0.84-2.30; P = .20). Both retrospective and prospective studies yield consistent findings. There is no association of RR with pre- or postoperative administration of ketorolac.
  
  
  CONCLUSIONS
  Ketorolac can be used safely in children, but is associated with a five-fold increased bleeding risk in adults.
authors: Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California.
authors: Dylan K
authors: DK
authors: Chan
authors: Sanjay R
authors: SR
authors: Parikh
mesh_terms: D000328:Adult; D000367:Age Factors; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D006801:Humans; D020910:Ketorolac / Q000009:adverse effects* / Q000627:therapeutic use; D010149:Postoperative Pain / Q000517:prevention & control; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D018570:Risk Assessment; D014068:Tonsillectomy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac
keywords: Tonsillectomy; hemorrhage; ketorolac; obstructive sleep apnea