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2.4. NSAID use and Gastrointestinal Risk

All NSAIDs may be associated with an increased risk of serious gastrointestinal (GI) adverse events, including potentially fatal GI bleeding, ulceration, or gastric/intestinal perforation. The risk of NSAID-associated severe GI adverse events increases in patients with a history of peptic ulcer disease, GI bleeding, smoking, alcohol use, concurrent use of anticoagulants or oral corticosteroids, advanced age, poor health and prolonged NSAID use. Ketorolac has a greater incidence of gastritis, gastric ulceration with or without perforation and gastric bleeding compared to other NSAIDs and is contraindicated for use in patients with a history of or active peptic ulcer disease, GI bleeding, or perforation, and should be used cautiously in patients with other types of GI disease (e.g., inflammatory bowel disease). Additionally, total systemic use for ketorolac is limited to 5 days due to increased incidence of severe adverse events, including GI events, with prolonged use.