Question: In Ask MAC it states : "As for Ketorolac, daily ASA is not considered anticoagulation therapy as it affect platelet function and does not result in a true anticoagulated state." So PLAVIX (clopidogrel) is also affect platelet function, even though ASA affects the cyclooxygenase 1 (COX-1) pathway, and PLAVIX affect the adenosine diphosphate (ADP) pathway, still I think both PLAVIX and ASA affect platelet function . And I think daily dose of PLAVIX also not a true anti-coagulated state and Ketorolac is not contra-indicated. Please let me know if I am right or wrong by those explanations.

Great pick up and reference to our May 13, 2014 Ask MAC where the question was posted, is daily ASA considered anticoagulation therapy for Ketorolac?  Where the answer was, daily ASA is not considered anticoagulation therapy as it affects platelet function and does not result in a true anticoagulated state you are right in that Clopidogrel (Plavix) also affects platelet function and when taken similarly to ASA, regularly as secondary prevention of atherothrombotic events, is not a true anticoagulated state.  Thus, it is not a contra-indication for ketorolac administration.

For those interested, and as rightly-stated in the question, Clopidogrel affects platelet function by being activated by CYP-450 to produce its thiol metabolite, which irreversibly binds ADP, preventing the activation of the GPIIb/IIIa receptor complex.  This complex allows fibrinogen binding and aggregation.  This results in the irreversible inhibition of platelet aggregation for the platelets lifespan (7-10 days).

Savi P et al.  Clopidogrel: a review of its mechanism of action.  Platelets. 1998;(3-4):251-255.

CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2015 [updated 2016 Feb 26; cited 2016 Mar 06].  Clopidogrel [product monograph]. Avaliable from: http://www.e-therapeutics.ca

Analgesia,Pain/Sedation/Nausea

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