Which NSAID carries the highest relative risk for GI bleeding?

Ketorolac is associated with the highest relative risk for gastrointestinal (GI) bleeding among nonsteroidal anti-inflammatory drugs (NSAIDs). This is primarily due to its potent analgesic properties, often leading to its use in acute pain management, and a higher dosage and longer duration of use compared to other NSAIDs can increase the risk of gastrointestinal side effects.

Ketorolac's mechanism of action as a nonselective COX inhibitor affects the production of protective gastric mucosa, thereby increasing the risk of ulcers and bleeding in the gastrointestinal tract. Clinicians often advise using ketorolac for short periods and monitor patients closely, particularly those at higher risk for GI complications.

In contrast, while other NSAIDs like ibuprofen, diclofenac, and meloxicam also bear risks for GI bleeding, their relative risk is generally lower than that of ketorolac, particularly when used at recommended doses and for brief durations. This distinction highlights the importance of careful consideration when prescribing ketorolac, especially in populations vulnerable to gastrointestinal issues.