Comparison of blood-conservation strategies in cardiac surgery patients at high risk for bleeding. Export

@article{citeulike:846603, abstract = {BACKGROUND: Aprotinin and tranexamic acid are routinely used to reduce bleeding in cardiac surgery. There is a large difference in agent price and perhaps in efficacy. METHODS: In a prospective, randomized, partially blinded study, 168 cardiac surgery patients at high risk for bleeding received either a full-dose aprotinin infusion, tranexamic acid (10-mg/kg load, 1-mg x kg(-1) x h(-1) infusion), tranexamic acid with pre-cardiopulmonary bypass autologous whole-blood collection (12.5\% blood volume) and reinfusion after cardiopulmonary bypass (combined therapy), or saline infusion (placebo group). RESULTS: There were complete data in 160 patients. The aprotinin (n = 40) and combined therapy (n = 32) groups (data are median [range]) had similar reductions in blood loss in the first 4 h in the intensive care unit (225 [40-761] and 163 [25-760] ml, respectively; P = 0.014), erythrocyte transfusion requirements in the first 24 h in the intensive care unit (0 [0-3] and 0 [0-3] U, respectively; P = 0.004), and durations of time from end of cardiopulmonary bypass to discharge from the operating room (92 [57-215] and 94 [37, 186] min, respectively; P = 0.01) compared with the placebo group (n = 43). Ten patients in the combined therapy group (30.3\%) required transfusion of the autologous blood during cardiopulmonary bypass for anemia. CONCLUSIONS: The combination therapy of tranexamic acid and intraoperative autologous blood collection provided similar reduction in blood loss and transfusion requirements as aprotinin. Cost analyses revealed that combined therapy and tranexamic acid therapy were the least costly therapies.}, address = {Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA. nuttall.gregory@mayo.edu}, author = {Nuttall, G. A. and Oliver, W. C. and Ereth, M. H. and Santrach, P. J. and Bryant, S. C. and Orszulak, T. A. and Schaff, H. V.}, citeulike-article-id = {846603}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/10719945}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=10719945}, issn = {0003-3022}, journal = {Anesthesiology}, keywords = {rccv}, month = {March}, number = {3}, pages = {674--682}, posted-at = {2006-09-16 18:19:03}, priority = {2}, title = {Comparison of blood-conservation strategies in cardiac surgery patients at high risk for bleeding.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/10719945}, volume = {92}, year = {2000} }

TY - JOUR ID - citeulike:846603 L3 - citeulike-article-id:846603 N2 - BACKGROUND: Aprotinin and tranexamic acid are routinely used to reduce bleeding in cardiac surgery. There is a large difference in agent price and perhaps in efficacy. METHODS: In a prospective, randomized, partially blinded study, 168 cardiac surgery patients at high risk for bleeding received either a full-dose aprotinin infusion, tranexamic acid (10-mg/kg load, 1-mg x kg(-1) x h(-1) infusion), tranexamic acid with pre-cardiopulmonary bypass autologous whole-blood collection (12.5% blood volume) and reinfusion after cardiopulmonary bypass (combined therapy), or saline infusion (placebo group). RESULTS: There were complete data in 160 patients. The aprotinin (n = 40) and combined therapy (n = 32) groups (data are median [range]) had similar reductions in blood loss in the first 4 h in the intensive care unit (225 [40-761] and 163 [25-760] ml, respectively; P = 0.014), erythrocyte transfusion requirements in the first 24 h in the intensive care unit (0 [0-3] and 0 [0-3] U, respectively; P = 0.004), and durations of time from end of cardiopulmonary bypass to discharge from the operating room (92 [57-215] and 94 [37, 186] min, respectively; P = 0.01) compared with the placebo group (n = 43). Ten patients in the combined therapy group (30.3%) required transfusion of the autologous blood during cardiopulmonary bypass for anemia. CONCLUSIONS: The combination therapy of tranexamic acid and intraoperative autologous blood collection provided similar reduction in blood loss and transfusion requirements as aprotinin. Cost analyses revealed that combined therapy and tranexamic acid therapy were the least costly therapies. IS - 3 JF - Anesthesiology SN - 0003-3022 AD - Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA. nuttall.gregory@mayo.edu EP - 682 TI - Comparison of blood-conservation strategies in cardiac surgery patients at high risk for bleeding. VL - 92 SP - 674 KW - rccv AU - Nuttall, GA AU - Oliver, WC AU - Ereth, MH AU - Santrach, PJ AU - Bryant, SC AU - Orszulak, TA AU - Schaff, HV PY - 2000/03// UR - http://view.ncbi.nlm.nih.gov/pubmed/10719945 ER -