Major
Ketorolac × Rivaroxaban
Non-steroidal anti-inflammatory drugs (NSAIDs)×Direct oral anticoagulants (factor Xa inhibitors)
Mechanism
Ketorolac inhibits platelet aggregation and strongly injures the gastric mucosa. Combined with rivaroxaban (direct factor Xa inhibitor): additive massive GI bleeding risk. FDA Toradol Section 4.3 lists anticoagulants as contraindications.
Symptoms
Black or tarry stools (melena), vomiting blood or coffee-ground material, epigastric pain. Risk multiplies in older patients and with prior peptic ulcer disease.
Management
The combination is not prescribed. For analgesia on rivaroxaban, use paracetamol (up to 3 g/day), metamizole, or a short opioid course. Ketorolac courses never exceed 5 days under any circumstances.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.