Ketorolac for aTAAD
Trial question
What is the effect of ketorolac in patients with acute type A aortic dissection?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
22.0% female
78.0% male
N = 109
109 patients (24 female, 85 male).
Inclusion criteria: adult patients with acute type A aortic dissection.
Key exclusion criteria: prolonged fasting or inability to self-feed; history of malignant tumors; body weight < 50 kg; traumatic aortic dissection; Marfan syndrome; requirement for endotracheal intubation prior to surgery; limb ischemia before surgery; liver disease; pregnancy or lactation.
Interventions
N=54 ketorolac (at a dose of 60 mg once IM 2 hours prior to surgery and 30 mg IM BID).
N=55 placebo (2 mL saline once IM 2 hours prior to surgery and 1 mL IM BID).
Primary outcome
Hospital death, organ malperfusion syndrome, permanent dialysis, tracheotomy, neurological impairment, unplanned cardiac reoperation, mechanical circulatory support, extracorporeal membrane oxygenation, or intra-aortic balloon pump
11.1%
12.7%
12.7 %
9.5 %
6.3 %
3.2 %
0.0 %
Ketorolac
Placebo
No significant
difference ↔
No significant difference in hospital death, organ malperfusion syndrome, permanent dialysis, tracheotomy, neurological impairment, unplanned cardiac reoperation, mechanical circulatory support, ECMO, or intra-aortic balloon pump (11.1% vs. 12.7%; ARD -1.6, 95% CI -12.7 to 9.5).
Secondary outcomes
Significant decrease in median intraoperative bleeding (1.8 L vs. 2 L; MD -0.2, 95% CI -0.38 to -0.02).
Significant decrease in median ICU stay (6.5 days vs. 8 days; MD -1.5, 95% CI -2.93 to -0.07).
No significant difference in pneumonia (7.4% vs. 21.8%; ARD -14.4, 95% CI -29.43 to 0.63).
Safety outcomes
No significant differences in postoperative hemorrhage within 24 hours > 1 L, renal failure, liver failure.
Conclusion
In adult patients with acute type A aortic dissection, ketorolac was not superior to placebo with respect to hospital death, organ malperfusion syndrome, permanent dialysis, tracheotomy, neurological impairment, unplanned cardiac reoperation, mechanical circulatory support, ECMO, or intra-aortic balloon pump.
Reference
Zhi-Kang Lv, Hai-Tao Zhang, Xiu-Juan Cai et al. Ketorolac in the perioperative management of acute type A aortic dissection: a randomized double-blind placebo-controlled trial. BMC Med. 2025 Mar 28;23(1):188.
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