Loading...
Please wait, while we are loading the content...
Similar Documents
Prophylaxis for post-perfusion CABG bleeding.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Jones, Ronald E. Cohn, Lawrence Harvey |
| Copyright Year | 1990 |
| Abstract | DelRossi et al reported a double-blind, randomized study utilizing epsilon aminocaproic acid (EACA) for prophylaxis against post-perfusion cardiopulmonary bypass bleeding. Several (Ither investigators have also demonstrated the efficacy of EACA for the reduction of post-cardiotomy bypass bleeding. However, several important issues were raised by this article which, we believe, should be addressed before the routine apphcatioln of EACA for cardiac stmrgical patients. Of the group (If 350 patients, 61 percent consisted of elective myocardial revascimlarization procedures. It is implied, though not stated, that only saphenous vein grafts were used. There was no mention (If the role of the internal mammary’ artery as a conduit which could possibly alter the otmtcome, especially with the use of bilateral internal mammary’ arteries since more extensive chest wall dissection and hence postoperative bleeding is encountered. Cardiopulmonary bypass times were not mentioned. The coagul(Ipathy and cellular destnmction associated with extended cardiopulmonary bypass perfusion may certainly alter total blood loss postoperatively. Several (Ither important factors related to polst-perfmsioln hemorrhage are clinically relevant lInt were not mentioned. These include: 1) the imse of aspirin and/or heparin immediately preoperatively; 2) the number (If units (If platelets, fresh frozen plasma and cryoprecipitate that may have been transfused postoperatively’; 3) the use ofdesmopressin acetate; 4) the utilization ofautotransfusion devices intraoperatively and postoperatively. Perhaps the authors could state whether any of these variables were used and whether there was any statistical difference between the control and the EACA-treated group. In the placebo group there is a 3.3 percent reoperation rate for bleeding. It is fl(It stated whether the patients exhibited any laboratory finding indicative of a hyperfibrinolytic state since no ol)vious bleeding site was identified at the time (If re-exploration. Finally, the study concludes that EACA should be utilized to decrease the t(Ital blood loss and the number of blood transfusions in routine elective cardiac operations. We think the ultimate test of EACA efficacy’ to reduce post-perfusi(In bleeding would probably be in patients with myocardial failure requiring the use (If intraaortic balloon, emergency operations, reoperative my-ocardial revascularization, and reoperative valve replacements. We believe that EACA should not be utilized routinely but only’ in selected patients at higher risk for post-perfusion bleeding. In that regard, we are curious if the authors currently routinely treat all of their patients undergoing elective, 1(1w-risk cardiac operations requiring cardiopulmonary bypass with EACA, or if it is utilized only in selected circumstances, as we have indicated above. We would certainly appreciate hearing from the authors on this very controversial paper. |
| Starting Page | E6 |
| Ending Page | E6 |
| Page Count | 1 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21616/516-b.pdf |
| Alternate Webpage(s) | http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21616/516-a.pdf |
| PubMed reference number | 2376203v1 |
| Volume Number | 98 |
| Issue Number | 2 |
| Journal | Chest |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | 6-Aminocaproic Acid Artificial cardiac pacemaker Aspirin Blood Transfusion Cardiac Surgery procedures Cardiopulmonary Bypass Chest wall structure Coronary Artery Bypass Surgery Gastrointestinal Hemorrhage HL7PublishingSubSection |
| Content Type | Text |
| Resource Type | Article |
