Risk of Hospitalization for Upper Gastrointestinal Tract Bleeding Associated With Ketorolac, Other Nonsteroidal Anti-inflammatory Drugs, Calcium Antagonists, and Other Antihypertensive Drugs

Abstract
APPROXIMATELY 30 million patients worldwide take nonsteroidal anti-inflammatory drugs (NSAIDs) every day. In addition to their anti-inflammatory and analgesic effects, NSAIDs have unwanted effects on the upper gastrointestinal tract, mainly by inhibition of the enzyme cyclooxygenase (COX).1 The gastroduodenal injury ranges from dyspepsia to fatal upper gastrointestinal tract bleeding (UGIB) and perforation. Many epidemiologic studies have shown that NSAIDs increase the risk of peptic ulcer bleeding 3- to 5-fold.2,3 Ketorolac tromethamine is an NSAID that has attracted the attention of a number of regulatory bodies after the reporting of fatal cases of gastrointestinal tract bleeding.4 A recent meta-analysis assessed the relative risk (RR) of UGIB associated with individual NSAIDs5; however, the effect of ketorolac could not be analyzed because of lack of information in the original studies.