Click here and see who are advancing transfusion alternatives and blood management.
Welcome to NoBlood.
You are currently accessing this Site as a guest which gives you limited access to most discussions and other features. By registering you will have access to post topics, communicate privately with other members (PM), respond to polls, upload content and access many other special features. Registration is fast, simple and absolutely free so please, register today!
If you have any problems with the registration process or your account login, please contact contact us. If you forgot your password, click here to request a new one.
|
01-25-2006, 03:35 PM
|
|
Registered User
|
|
Join Date: Jan 2003
Posts: 1,438
Thanks: 7
Thanked 115 Times in 67 Posts
|
|
|
NEJM - The Risk Associated with Aprotinin in Cardiac Surgery
http://content.nejm.org/cgi/content/.../353?query=TOC
The Risk Associated with Aprotinin in Cardiac Surgery
Dennis T. Mangano, Ph.D., M.D., Iulia C. Tudor, Ph.D., Cynthia Dietzel, M.D., for the Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation
| ABSTRACT
Background The majority of patients undergoing surgical treatment for ST-elevation myocardial infarction receive antifibrinolytic therapy to limit blood loss. This approach appears counterintuitive to the accepted medical treatment of the same condition — namely, fibrinolysis to limit thrombosis. Despite this concern, no independent, large-scale safety assessment has been undertaken.
Methods In this observational study involving 4374 patients undergoing revascularization, we prospectively assessed three agents (aprotinin [1295 patients], aminocaproic acid [883], and tranexamic acid [822]) as compared with no agent (1374 patients) with regard to serious outcomes by propensity and multivariable methods. (Although aprotinin is a serine protease inhibitor, here we use the term antifibrinolytic therapy to include all three agents.)
Results In propensity-adjusted, multivariable logistic regression (C-index, 0.72), use of aprotinin was associated with a doubling in the risk of renal failure requiring dialysis among patients undergoing complex coronary-artery surgery (odds ratio, 2.59; 95 percent confidence interval, 1.36 to 4.95) or primary surgery (odds ratio, 2.34; 95 percent confidence interval, 1.27 to 4.31). Similarly, use of aprotinin in the latter group was associated with a 55 percent increase in the risk of myocardial infarction or heart failure (P<0.001) and a 181 percent increase in the risk of stroke or encephalopathy (P=0.001). Neither aminocaproic acid nor tranexamic acid was associated with an increased risk of renal, cardiac, or cerebral events. Adjustment according to propensity score for the use of any one of the three agents as compared with no agent yielded nearly identical findings. All the agents reduced blood loss. Conclusions The association between aprotinin and serious end-organ damage indicates that continued use is not prudent. In contrast, the less expensive generic medications aminocaproic acid and tranexamic acid are safe alternatives.
__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email
|
You are currently accessing this Site as a guest. Please login or register by clicking Here
Similar Threads
Yes, for the price of a cup of coffee, you can help NoBlood continue its mission to advance knowledge and
awareness of transfusion alternatives, blood conservation, blood management, bloodless medicine and bloodless surgery.
Linear Mode
