Comparison of the Frequency of Gastrointestinal Bleeding Complications Resulting from the use of Ketorolac after Gastrointestinal Cancer Surgery with or without Gastric Ulcer Prophylaxis - A Case Control Study

Mehran Kouchek1, Sadegh Zarei2, Reza Hosseiniara3, MirMohammad Miri1, *
1 Department of Anesthesiology and Critical Care, School of Medicine, Emam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Clinical Biochemistry, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
3 Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty, Kazakhstan

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© 2023 Kouchek et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Anesthesiology and Critical Care, School of Medicine, Emam Hosein Hospital, Shahid Beheshti University of Medical Sciences, 1617763141, Tehran, Iran; Tel: +982173433000; Fax: +982177558001; E-mail:



Gastrointestinal (GI) bleeding after GI cancer surgery is not very common, but the use of NSAIDs such as Ketorolac can aggravate it, and if not controlled properly, it may be life-threatening. Therefore, an NSAID/PPI combination (ketorolac and Pantoprazole) that reduces the adverse effect of ketorolac on GI bleeding can be very important.


The aim of this observational study is to compare the frequency of GI bleeding complications resulting from the use of Ketorolac after GI cancer surgery with or without gastric ulcer prophylaxis (Pantoprazole).


In this retrospective case-control study, the medical files of adult patients aged 18-60 years undergoing GI cancer surgery referred to 3 hospitals in Iran in 2022 were reviewed. The case group consisted of patients who received ketorolac (30 mg every 8 hours, intravenously) with preventive Pantoprazole (40 mg daily). The control group consisted of patients who only received ketorolac (30 mg every 8 hours, intravenously). Patients were matched in groups based on demographic and clinical variables. Outcomes, including GI bleeding (melena, ...), length of hospital and ICU stay, receiving packed cells, intubation, hematocrit and hemoglobin, were compared between the groups.


Two groups were matched in terms of age, gender, comorbidities, type of surgery, duration of surgery (hours), and surgical bleeding (ml) (P>0.05). Examination of clinical outcomes showed that GI bleeding complications were not significantly different in the two groups. Although in the case group that received ketorolac and Pantoprazole combination, GI bleeding complications were reported in a smaller number of people. The hospital stay (days) was significantly lower in the case group than in the control group. The ICU stay (hours), packed cells, intubation, hematocrit, and hemoglobin were not significantly different between the two groups.


The findings of the current study showed that the administration of Pantoprazole plus ketorolac might be effective in controlling bleeding in GI cancer surgery patients, which, of course, requires detailed and multicenter interventional studies.

Keywords: Gastrointestinal bleeding, Gastrointestinal cancer, Ketorolac, Pantoprazole, ICU, NSAID/PPI.