tailieunhanh - Báo cáo y học: "Increased bleeding risk associated with the use of recombinant human activated protein C in patients with advanced liver diseas"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Increased bleeding risk associated with the use of recombinant human activated protein C in patients with advanced liver disease. | Available online http content 12 1 405 Letter Increased bleeding risk associated with the use of recombinant human activated protein C in patients with advanced liver disease Adam Keene1 Thomas Kawano2 Syed Anees3 and Julie Chen4 Division of Critical Care Medicine Montefiore Medical Center Bronx New York USA 2Department of Internal Medicine Montefiore Medical Center Bronx New York USA 3Division of Pulmonary Medicine Montefiore Medical Center Bronx New York USA 4Division of Pharmacy Montefiore Medical Center Bronx New York USA Corresponding author Adam Keene akeene@ Published 11 February 2008 This article is online at http content 12 1 405 2008 BioMed Central Ltd Critical Care 2008 12 405 doi cc6774 Advanced liver disease ALD was an exclusion criteria from enrollment in the major clinical trials of recombinant human activated protein C APC but is listed on the package insert as a relative contraindication rather than an absolute contraindication to APC administration 1 . There are recent reports of elevated rates of bleeding due to APC in clinical practice particularly in patients with relative contraindications to the drug 2 3 . Since many patients who develop septic shock at Montefiore Medical Center in the Bronx New York have ALD we decided to evaluate whether such patients have an increased risk for bleeding during APC administration. We retrospectively reviewed a database of all adult patients who have received APC at Montefiore Medical Center since the drug s approval. All patients at Montefiore Medical Center with severe sepsis at high risk for death and without absolute contraindications are considered eligible for APC at the discretion of the attending intensivist. Overall 41 patients Table 1 Patient characteristics and outcomes Variable ALD present n 10 ALD absent n 24 P value APACHE II mean standard deviation Age years mean standard deviation Male gender n 6