Hi, I Recently Has A Severe Post Tonsillectomy Bleed. In

Posted on Sun, 2 Feb 2020

Question: Hi, I recently has a severe post tonsillectomy bleed. In the emergency department prior to the ENT consult and surgery, I was administered 30mg of Toradol. I am confused because my understanding is that NSAIDs are associated with risk of bleeding and a contraindication for patients with an incomplete hemostasis. I just wanted to get a professional opinion on the situation.

Hi, the bleed was on the left side and after the bleed was controlled about 3 litres of blood loss were estimated. It was a secondary bleed on the 7th day post op following a very small and controlled bleed on same day of surgery. I don’t have any history of bleeding disorders or any relevant things of this nature. The Toradol was administered shortly after arriving to the emergency department IV. I just wanted to see whether you felt that it could have contributed to further bleeding during the period before it was controlled.

It was estimated 500cc of fresh blood from the site in surgery was suction plus 1.5 litres of blood from my stomach. This was all after I had hematemesis of about 1 litre prior to going to the OR

Answered by Dr. Dr. Naveen Kumar Nanjasetty (4 hours later)

Brief Answer:
Post surgical bleed could be due to infection or erosion of blood vessels

Detailed Answer:
Hi

Thanks for posting the query

Any bleeding following tonsillectomy after the day 1 till the day 7 is called secondary bleeding. This is commonly due to the presence of infection or sloughing in the surgical site causing erosion of the blood vessels.

This is quite uncommon nowadays. I doubt the role of Ketorolac injection in this torrential bleed. In my routine clinical practice NSAIDs are administered following tonsillectomy according to their body weight and no bleeding has ever been noticed.

NSAIDs like aspirin do avoid the platelet aggregation and prolong the bleeding. But, routinely aspirin would be stopped at least 1 week before the surgery.

Hence, Ketorolac injection is not the cause of your tonsillar bleed.

Hope this answers your query. I will be available for the follow up queries.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Raju A.T