Major
Ketorolac × Warfarin
Non-steroidal anti-inflammatory drugs (NSAIDs)×Vitamin K antagonist anticoagulants
Mechanism
Ketorolac is the most potent available NSAID. It inhibits platelet aggregation and strongly injures the gastric mucosa. On warfarin, massive GI bleeding risk multiplies. FDA Toradol Section 4.3 lists anticoagulants as contraindications.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, blood in urine or stool, menorrhagia. Severe cases include gastrointestinal or intracranial haemorrhage. Risk rises in patients over 65 and with prior peptic ulcer disease.
Management
The combination is not prescribed. For analgesia on warfarin, use paracetamol (up to 2 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.