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Thrombocytopenia and Ketorolac

Question# 709

Why is thrombocytopenia not a contraindication for Ketorolac administration but being on a blood thinner is?


You are correct in your assessment that NSAIDS block prostaglandins and therefore can impact a patient with thrombocytopenia which can lead to an increase risk of bleeding.

It is important to understand the risk/benefit for any patient you engage with and what you understand about the treatment you are offering.

We don't limit NSAIDS in the elderly however, there is an increased risk of GI bleeding and therefore we teach medics to evaluate that risk.

Therefore, we could add it to the Medical directive however, paramedics should use their clinical judgement, understand the pharmacology, and and engage in these discussions with patients during their history taking. This is about being an expert in what you carry and administer as a practitioner, not what is written on the Medical Directive - we can't put it all!

That being said, one dose of Ibuprofen or Ketorolac to someone who has thrombocytopenia will not cause serious harm - the concern is more around long term use.

In summary, the risk is lower in this patient population therefore, if someone is in pain, the benefit of treating their pain might out way the low risk of potential bleeding.



01 June 2023



Please reference the MOST RECENT ALS PCS for updates and changes to these directives.