Pengaruh dari Ketorolac dan Metamizole terhadap Hemostasis: A Literature Review

Iwan Setiawan Adji (Faculty of Medicine, University Of Muhammadiyah Surakarta (UMS), Jalan Ahmad Yani, Sukoharjo, 57169, Central Java, Indonesia)
Yasinta Rizky Wulandari (Department of Ear, Nose, Throat, Head and Neck Surgery (ENT-BKL), University Of Muhammadiyah)
I Gede Budiastra Yandita Putra (Department of Ear, Nose, Throat, Head and Neck Surgery (ENT-BKL), University Of Muhammadiyah)
Hetty Soelakmi Bekti (Department of Ear, Nose, Throat, Head and Neck Surgery (ENT-BKL), University Of Muhammadiyah)
Firstiara Alifah Putriasari (Department of Ear, Nose, Throat, Head and Neck Surgery (ENT-BKL), University Of Muhammadiyah)
Muhammad Ihsanul Fikri (Department of Ear, Nose, Throat, Head and Neck Surgery (ENT-BKL), University Of Muhammadiyah)

MAHESA : Malahayati Health Student Journal
Vol 6, No 8 (2026): Volume 6 Nomor 8 (2026)

ABSTRACT Ketorolac and metamizole are non-opioid analgesics widely used in perioperative practice, but both have the potential to affect hemostasis through different pharmacological mechanisms. Understanding this risk profile is essential to ensure patient safety. A literature review was conducted by evaluating experimental, observational, and clinical trials that addressed the effects of both drugs on platelet function, coagulation, and perioperative bleeding incidence. Ketorolac majorly inhibits thromboxane A₂ synthesis through COX-1 inhibition, thereby reducing platelet aggregation and increasing the risk of bleeding in certain procedures. Metamizole exhibits more heterogeneous effects; some studies report inhibition of platelet aggregation and interference with the effects of aspirin, while others show minimal impact on hemostasis. The choice of analgesic should consider the risk profile of each drug, the patient's clinical condition, and potential pharmacological interactions. An individualized approach is necessary to optimize analgesia while maintaining the integrity of perioperative hemostasis. Keywords: Ketorolac, Metamizole, Hemostasis, Blood Coagulation.  ABSTRAK Ketorolac dan metamizole merupakan analgesik non-opioid yang banyak digunakan dalam praktik perioperatif, namun keduanya memiliki potensi memengaruhi hemostasis melalui mekanisme farmakologis yang berbeda. Pemahaman terhadap profil risiko ini penting untuk memastikan keselamatan pasien. Tinjauan literatur dilakukan dengan mengevaluasi penelitian eksperimental, observasional, dan uji klinis yang membahas efek kedua obat terhadap fungsi trombosit, koagulasi, dan insiden perdarahan perioperative. Ketorolac secara garis besar menghambat sintesis tromboksan A₂ melalui inhibisi COX-1, sehingga menurunkan agregasi trombosit dan meningkatkan risiko perdarahan pada prosedur tertentu. Metamizole menunjukkan efek yang lebih heterogen; sebagian studi melaporkan hambatan agregasi trombosit dan interferensi terhadap efek aspirin, sementara yang lain menunjukkan dampak minimal terhadap hemostasis. Pemilihan analgesik harus mempertimbangkan profil risiko masing-masing obat, kondisi klinis pasien, dan potensi interaksi farmakologis. Pendekatan individual diperlukan untuk mengoptimalkan analgesia sembari menjaga integritas hemostasis perioperatif. Kata Kunci: Ketorolac, Metamizole, Hemostasis, Pembekuan Darah.