tailieunhanh - Báo cáo y học: "Mortality associated with administration of highdose tranexamic acid and aprotinin in primary open-heart procedures: a retrospective analysis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Mortality associated with administration of highdose tranexamic acid and aprotinin in primary open-heart procedures: a retrospective analysis. | Sander et al. Critical Care 2010 14 R148 http content 14 4 R148 c CRITICAL CARE RESEARCH Open Access Mortality associated with administration of high-dose tranexamic acid and aprotinin in primary open-heart procedures a retrospective analysis 1 1 1 1 2 Michael Sander Claudia D Spies Viktoria Martiny Christoph Rosenthal Klaus-Dieter Wernecke Christian von Heymann1 Abstract Introduction Antifibrinolytic agents are commonly used during cardiac surgery to minimize bleeding. Because of safety concerns aprotinin was withdrawn from the market in 2007. Since then tranexamic acid TXA has become the antifibrinolytic treatment of choice in many heart centers. The safety profile of TXA has not been extensively studied. Therefore the aim of this study was to evaluate safety and efficiency of TXA compared with aprotinin in cardiac surgery. Methods Since July 1 2006 TXA has been administered at a dose of 50 mg kg tranexamic acid before cardiopulmonary bypass CPB and 50 mg kg into the priming fluid of the CPB. Prior to this all patients were treated with aprotinin at a dose of 50 000 KIU per kilogram body weight. Safety was evaluated with mortality biomarkers and the diagnosis of myocardial infarction ischemic stroke convulsive seizures and acute renal failure in the intensive care unit ICU intermediate care unit IMCU and hospital stay. Efficiency was evaluated by the need for transfusion of blood products and total postoperative blood loss. Results After informed consent 893 patients were included in our database 557 consecutive patients receiving aprotinin and 336 patients receiving TXA . A subgroup of 320 patients undergoing open-heart procedures 105 receiving TXA and 215 receiving aprotinin was analyzed separately. In the aprotinin group a higher rate of late events of ischemic stroke versus P and neurologic disability versus P was found. The rate of postoperative convulsive seizures was increased in tendency in patients receiving TXA