Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 228
Filtrar
1.
Am Surg ; 86(3): 228-231, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223802

RESUMO

Estimated blood loss (EBL) is an increasingly important factor used to predict outcomes, such as morbidity and mortality, length of stay, and readmissions, after major abdominal operations. However, blood loss is difficult to estimate, with frequent under- and overestimations, consequences of which can be potentially dangerous for individual patients and confounding for scoring systems relying on EBL. We hypothesized that EBL is often inaccurate and have prospectively enrolled consecutive patients undergoing major elective intra-abdominal operations. Actual hemoglobin levels were measured and used to calculate the measured blood loss (MBL), which was compared with the EBL, as estimated both by surgeons (sEBL) and anesthesiologists (aEBL). Of 23 eligible cases at interim analysis, pancreaticoduodenectomy (n = 8) was the most common, followed by colectomy (n = 3), hepatectomy (n = 3) and gastrectomy (n = 2), biliary excision and reconstruction (n = 2), combined gastrectomy + colectomy (n = 1), radical nephrectomy (n = 1), open cholecystectomy (n = 1), pancreatic debridement (n = 1), and exploratory laparotomy (n = 1). aEBL overestimated MBL by 192 mL (143%) on average. The aEBL was significantly greater than the MBL (P = 0.004), whereas the sEBL was significantly less than the MBL (P = 0.009). In conclusion, surgeons significantly underestimate and anesthesiologists significantly overestimate EBL. This finding impacts not only immediate patient care but also the interpretation of scoring systems relying on EBL.


Assuntos
Perda Sanguínea Cirúrgica/fisiopatologia , Causas de Morte , Neoplasias do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos Eletivos/métodos , Melhoria de Qualidade , Cavidade Abdominal/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica/mortalidade , Estudos de Coortes , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/patologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Análise de Sobrevida
2.
Medicine (Baltimore) ; 98(45): e17816, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702635

RESUMO

Massive blood transfusion (MBT) increased mortality and morbidity after cardiac surgery. However, a mid-term follow-up study on repair surgery of acute type A aortic dissection (AAAD) with MBT was lacking. This study aimed to assess the impact of perioperative MBT on late outcomes of surgical repair for AAAD.There were 3209 adult patients firstly received repair surgery for AAAD between 2005 and 2013, were identified using Taiwan National Health Insurance Research Database. Primary interest variable was MBT, defined as transfused red blood cell (RBC) ≥10 units.The outcomes contained in-hospital mortality, surgical-related complications, all-cause mortality, respiratory failure, and chronic kidney disease (CKD) during follow-up period. Higher in-hospital mortality (37.7% vs 11.6%; odds ratio, 4.00; 95% confidence interval [CI], 3.30-4.85), all-cause mortality (26.1% vs 13.0%; hazard ratio [HR], 1.66; 95% CI, 1.36-2.04), and perioperative complications were noted in the MBT group. A subdistribution hazard model revealed higher cumulative incidence of CKD (13.9% vs 6.5%; HR, 1.95; 95% CI, 1.47-2.60) and respiratory failure (7.1% vs 2.7%; HR, 2.34; 95% CI, 1.52-3.61) for the MBT cohort. A dose-dependent relationship between amount of transfused RBC (classified as tertiles) and cumulative incidence of all-cause mortality, incident CKD, and respiratory failure was found (P of trend test <.001).Patients with MBT had worse late outcomes following surgical repair of AAAD. The cumulative incidence of all-cause mortality, incident CKD, and respiratory failure increased with the amount of transfused RBC in a dose-dependent manner.


Assuntos
Aneurisma Dissecante/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/mortalidade , Perda Sanguínea Cirúrgica/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taiwan , Resultado do Tratamento , Adulto Jovem
3.
Transfus Apher Sci ; 58(4): 412-415, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31285133

RESUMO

Patient blood management (PBM) aims to reduce red blood cell transfusion, minimize preoperative anemia, reduce intraoperative blood loss as well as optimize hemostasis, and individually manage postoperative anemia. Benefits include improved clinical outcome with a reduction in patient morbidity and mortality, but also lower hospital costs and shorter hospital length of stay. To date, it has been successfully implemented in several medical specialties, such as cardiac, trauma and orthopedic surgery. In obstetrics, postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality. PBM has the potential to improve outcome of mother and child. However, pregnancy and childbirth pose a special challenge to PBM, and several adaptations compared to PBM in elective surgery are necessary. To date, awareness of the clinical advantages of PBM among obstetricians and midwifes regarding PBM and its concept in PPH is limited. In the following review, we therefore aim to present the current status quo in PBM in obstetrics and its challenges in the clinical routine.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Parto Obstétrico , Procedimentos Cirúrgicos Eletivos , Hemostasia , Hemorragia Pós-Parto/terapia , Perda Sanguínea Cirúrgica/mortalidade , Feminino , Humanos , Mortalidade Materna , Hemorragia Pós-Parto/mortalidade
4.
J Cardiothorac Surg ; 14(1): 98, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151461

RESUMO

OBJECTIVES: Despite a long history of concerns regarding patient safety during clinical care, some patients undergoing thoracic surgery continue to experience adverse events (AEs). AEs are a major significant source of perioperative morbidity and mortality following thoracic surgery. This study analysed the causes, treatment and prognosis of perioperative AEs to provide a reference for further surgical safety. METHODS: The authors collected a total of 62,571 thoracic surgery anaesthesia records via the Anaesthesia Information Management System (AIMS) from 14 August 2006 to 14 August 2017 and obtained 150 cases of perioperative serious AEs from the "adverse events registration" subsystem. The related hospitalization data of the 150 patients were analysed, including anaesthesia, recovery room time, ICU records and follow-up outcomes. The causes of these AEs were classified as follows: events related to the patients' pathogenic conditions(P); surgery-related factors(S); anaesthesia-related factors(A); and interactions between pathogenic, surgical and anaesthesia factors (P&S&A). We then analysed the main clinical manifestations, causes and treatment of these events. RESULTS: The overall rate of perioperative AEs in thoracic surgery (n = 62,571) was 0.2%. Of these, 10.7% were. caused by P and 23.3% by A; neither cause led to patient death. S and P&S&A accounted for 55.3 and 10.7% of AEs, respectively; together, they accounted for 66%. Twelve patients with postoperative AEs caused by S or P&S&A died within 3 days (8% of 150 cases). A total of 33%(50/150) of patients experienced sudden cardiac arrest (SCA) and recovered successfully. Surgical massive haemorrhage (22%, 33/150) was reported as a predominant mortality-related outcome in this group, and 8 of the 12 deaths were caused by massive haemorrhage. CONCLUSIONS: The rate of perioperative AEs after thoracic surgery was 0.2%. AEs must be identified and treated immediately. An important factor in anaesthesia-related events was respiratory management. Two major clinical manifestations of surgery-related events were cardiac arrest and massive haemorrhage. Cardiac arrest was the major factor contributing to AEs, but its adverse consequences could be avoided with timely discovery and proper treatment. Massive haemorrhage is a significant cause of mortality that can be prevented with a surgeon's early diagnosis and appropriate interventions.


Assuntos
Anestesia/efeitos adversos , Países em Desenvolvimento/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Complicações Intraoperatórias/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Perda Sanguínea Cirúrgica/mortalidade , China/epidemiologia , Parada Cardíaca/etiologia , Humanos , Complicações Intraoperatórias/epidemiologia , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Prognóstico , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
5.
J Pediatr Surg ; 54(9): 1736-1739, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31103272

RESUMO

PURPOSE: The risks of laparotomy during extracorporeal life support (ECLS) are poorly defined. We examined risk factors associated with bleeding and mortality after laparotomy on ECLS. METHODS: The Extracorporeal Life Support Organization (ELSO) database was queried for all pediatric patients [0-17 years] with a procedure code for laparotomy. Outcome data were analyzed to define factors contributing to laparotomy complications and mortality while on ECLS. Univariate and multivariate analyses were applied to determine independent risk factors. RESULTS: 196 patients who met inclusion criteria were identified. The mortality rate in the entire cohort was 67.3%. In both univariate and multivariate analyses, surgical site bleeding did not significantly increase the risk of mortality (OR 0.8; 95% CI 0.4-1.7). Logistic regression analysis revealed that lower gestational age, infectious complications and nonsurgical site hemorrhagic complications were independently increased mortality risk (all p < 0.05). CONCLUSION: Mortality following laparotomy on ECLS is not independently associated with surgical site bleeding, but is associated with lower gestational age, infectious and nonsurgical site hemorrhagic complications. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.


Assuntos
Perda Sanguínea Cirúrgica , Oxigenação por Membrana Extracorpórea , Laparotomia , Adolescente , Perda Sanguínea Cirúrgica/mortalidade , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Criança , Pré-Escolar , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Laparotomia/efeitos adversos , Laparotomia/mortalidade , Laparotomia/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
6.
J Pediatr Surg ; 54(10): 2044-2047, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31103273

RESUMO

BACKGROUND/PURPOSE: Prosthetic patch (patch) and muscle flap (flap) techniques are utilized for severe congenital diaphragmatic hernia (CDH) repair; however, when performed on extracorporeal membrane oxygenation (ECMO), the risk of hemorrhage increases. We sought to compare bleeding complications between repair types. METHODS: We retrospectively reviewed 2010-2016 on-ECMO CDH repairs. RESULTS: Twenty-nine patients met criteria: 13 patch (44.8%) and 16 flap (55.2%). Eight patch (61.5%) and 13 flap (81.2%) patients had left-sided defects (p = 0.223). All defects were Type C or D (Type C: patch 53.8%, flap 56.2%, p = 0.596). There was no difference in gestational age at delivery (patch 37.5 ±â€¯0.9 weeks, flap 37.2 ±â€¯1.3 weeks, p = 0.390) or age at repair (patch 7.46 ±â€¯6.6 days, flap 6.00 ±â€¯4.3 days, p = 0.476). Seven patch (53.8%) and 9 flap (56.2%) patients survived to discharge (p = 0.596). Estimated intraoperative blood loss was equivalent (patch 35.3 ±â€¯53.9 mL, flap 24.2 ±â€¯18.4 mL, p = 0.443). One patch patient (7.6%) and two (12.5%) flap patients required reoperation in the first 48 h for bleeding (p = 0.580). 48-h postoperative transfusions were the same for those that required reoperation (patch 282.0 mL/kg, flap 208.5 ±â€¯21.9 mL/kg, p = 0.054) and those that did not (patch 120.7 ±â€¯111.7 mL/kg, flap 118.4 ±â€¯89.9 mL/kg, p = 0.561). CONCLUSIONS: On-ECMO bleeding complications are equivalent for both flap and patch CDH repair. LEVEL OF EVIDENCE: Type III (retrospective comparative study).


Assuntos
Perda Sanguínea Cirúrgica , Oxigenação por Membrana Extracorpórea , Hérnias Diafragmáticas Congênitas , Retalhos Cirúrgicos/estatística & dados numéricos , Perda Sanguínea Cirúrgica/mortalidade , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Oxigenação por Membrana Extracorpórea/mortalidade , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Hérnias Diafragmáticas Congênitas/mortalidade , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Recém-Nascido , Próteses e Implantes/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos
7.
Clin Transl Oncol ; 21(9): 1197-1206, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30689183

RESUMO

BACKGROUND: Whether intraoperative blood loss (IBL) was independently associated with poor prognosis of gastric cancer (GC) patients remains controversial. In the present study, we evaluated the impact of IBL on the disease-free survival (DFS) of GC patients. METHODS: A total of 1669 patients who underwent curative gastrectomy for GC were reviewed retrospectively. All patients were classified as IBL < 400 mL and IBL ≥ 400 mL group according to the amount of IBL. The prognostic difference between two patient groups was compared and clinicopathologic factors associated with the prognosis of GC patients were analyzed. RESULTS: The 5-year DFS rate of the patients with IBL < 400 mL and those with IBL ≥ 400 mL was 52.1% and 41.5%, respectively (P < 0.001). The 5-year DFS rate of the patients who did and did not receive intraoperative blood transfusion was 36.9% and 53.2%, respectively (P < 0.001). However, the similar survival outcomes were not observed in the subgroup analysis based on the TNM stage. The multivariate analysis indicated that IBL (HR 1.021, 95% CI 0.875-1.191, P > 0.05) and intraoperative blood transfusion (HR 1.111, 95% CI 0.943-1.309, P > 0.05) were not independent prognostic factors for GC patients. In addition, the patients with IBL ≥ 400 mL had a higher risk of postoperative complications than those with IBL < 400 mL, especially for intraabdominal infection and wound infection. The tumor located in upper 1/3 stomach, total gastrectomy, combined organ resection and advanced tumor stage (stage III) were independent risk factors for intraoperative massive hemorrhage. CONCLUSION: Intraoperative blood loss was significantly associated with tumor-related and surgery-related factors. Intraoperative blood loss itself could not independently affect survival outcome of GC patients after curative gastrectomy.


Assuntos
Perda Sanguínea Cirúrgica/mortalidade , Transfusão de Sangue/métodos , Gastrectomia/mortalidade , Complicações Intraoperatórias/mortalidade , Neoplasias Gástricas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Adulto Jovem
8.
Ann Vasc Surg ; 56: 194-201, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30476610

RESUMO

BACKGROUND: Little is known about late-onset primary malignant neoplasms after repair of abdominal aortic aneurysms (AAAs) despite malignancy being one of the primary causes of late death. We investigated the incidence and prognostic factors related to the occurrence of malignancy after AAA repair. METHODS: We performed a retrospective analysis of 589 patients who underwent AAA repair, including 264 endovascular AAA repairs and 325 open surgical repairs; 482 patients had no history of previous malignancy or concomitant malignancy, 72 had previous malignancy, and 35 had concomitant malignancy in remission at the time of AAA repair. The cumulative incidence rates of late-onset malignancy occurrence and cancer death were estimated using the cumulative incidence function in the presence of competing risks, that is, noncancer death, and prognostic factors were investigated using the Fine-Gray hazard model. RESULTS: After hospital discharge, 128 malignancies occurred in 116 patients. Overall cumulative incidence rates of late-onset malignancy occurrence at 1, 3, 5, and 10 years were 4.0%, 11.7%, 18.2%, and 38.1%, respectively. Multivariate analysis revealed that significant prognostic factors for late-onset malignancy included history of previous malignancy, current smoker, higher intraoperative blood loss, absence of allogeneic blood transfusion, lower C-reactive protein levels, and lower serum high-density lipoprotein-cholesterol levels. The type of surgical procedures for AAA repair did not affect the occurrence of malignancy. In addition, current smoker and higher intraoperative blood loss significantly increased the risk of cancer death. CONCLUSIONS: Current smoker and higher intraoperative blood loss were independent risk factors for late-onset malignancy after AAA repair. Late-onset malignancy after AAA repair should be monitored among patients at high risk and requires aggressive management to improve long-term survival.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Neoplasias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Perda Sanguínea Cirúrgica/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Causas de Morte , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Fatores de Tempo , Resultado do Tratamento
9.
J Cardiothorac Vasc Anesth ; 33(2): 307-317, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30269889

RESUMO

OBJECTIVES: Rotational thromboelastometry (ROTEM)-guided transfusion algorithms in cardiac surgery have been proven to be successful in reducing blood loss in randomized controlled trials. Using an institutional hemostasis registry of patients in cardiac surgery (HEROES-CS), the authors hypothesized that the use of ROTEM-guided transfusion algorithms would save blood products and overall costs in cardiac surgery in every day practice. DESIGN: Observational, prospective open cohort database. SETTING: Single-center academic hospital. PARTICIPANTS: Cardiac surgery patients. INTERVENTIONS: Implementation of ROTEM-guided bleeding management. MEASUREMENTS AND MAIN RESULTS: A classical-guided algorithm and a ROTEM-guided algorithm were used for patient blood management in 2 cohorts. Primary outcome was the use and amount of blood products and hemostatic medication. Secondary outcomes were amount of rethoracotomies, length of stay, and 30-day mortality. Finally, costs and savings were calculated. The classical-guided cohort comprised 204 patients, and ROTEM-guided cohort comprised 151 patients. Baseline characteristics showed excellent similarities after propensity score matching of 202 patients. Blood loss was lower after ROTEM guidance (p < 0.001). Absolute risk reduction was 17% for red blood cells (p = 0.024), 12% for fresh frozen plasma (p = 0.019), and 4% for thrombocyte concentrates (p = 0.582). More tranexamic acid was given, but not more fibrinogen concentrate, while desmopressin was given less often. Hospital length of stay was reduced by an overall median of 2 and a mean of 4 days (p < 0.001). Mortality and rethoracotomy rates were not affected. Potential savings were about €4,800 ($5,630) per patient. CONCLUSIONS: Implementation of a ROTEM-guided transfusion algorithm in cardiac surgery patients reduced the use of blood products and hemostatic medication, hereby saving costs. Reductions in mortality and rethoracotomy rates could not be found.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/métodos , Procedimentos Cirúrgicos Cardíacos , Hemostasia/fisiologia , Hemorragia Pós-Operatória/prevenção & controle , Sistema de Registros , Tromboelastografia/métodos , Idoso , Algoritmos , Perda Sanguínea Cirúrgica/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/mortalidade , Pontuação de Propensão , Estudos Prospectivos , Taxa de Sobrevida/tendências
10.
Anesth Analg ; 127(5): 1180-1188, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29944520

RESUMO

BACKGROUND: Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion-related fatalities. While these transfusion-related pulmonary complications (TRPCs) have been well detailed in adults, their burden in pediatric subsets remains poorly defined. We sought to delineate the incidence and epidemiology of pediatric TRPCs after intraoperative blood product transfusion. METHODS: In this retrospective cohort study, we evaluated all consecutive pediatric patients receiving intraoperative blood product transfusions during noncardiac surgeries between January 2010 and December 2014. Exclusion criteria were cyanotic heart disease, preoperative respiratory insufficiency, extracorporeal membrane oxygenation, and American Society of Anesthesiologists physical status VI. Medical records were electronically screened to identify those with evidence of hypoxemia, and in whom a chest x-ray was obtained within 24 hours of surgery. Records were then manually reviewed by 2 physicians to determine whether they met diagnostic criteria for TACO or TRALI. Disagreements were adjudicated by a third senior physician. RESULTS: Of 19,288 unique pediatric surgical patients, 411 were eligible for inclusion. The incidence of TRPCs was 3.6% (95% confidence interval [CI], 2.2-5.9). TACO occurred in 3.4% (95% CI, 2.0-5.6) of patients, TRALI was identified in 1.2% (95% CI, 0.5-2.8), and 1.0% (95% CI, 0.4-2.5) had evidence for both TRALI and TACO. Incidence was not different between males (3.4%) and females (3.8%; P = .815). Although a trend toward an increased incidence of TRPCs was observed in younger patients, this did not reach statistical significance (P = .109). Incidence was comparable across subsets of transfusion volume (P = .184) and surgical specialties (P = .088). Among the 15 patients experiencing TRPCs, red blood cells were administered to 13 subjects, plasma to 3, platelets to 3, cryoprecipitate to 2, and autologous blood to 3. Three patients with TRCPs were transfused mixed blood components. CONCLUSIONS: TRPCs occurred in 3.6% of transfused pediatric surgical patients, with the majority of cases attributable to TACO, congruent with adult literature. The frequency of TRPCs was comparable between genders and across surgical procedures and transfusion volumes. The observed trend toward increased TRPCs in younger children warrants further consideration in future investigations. Red blood cell administration was the associated component for the majority of TRPCs, although platelets demonstrated the highest risk per component transfused. Mitigation of perioperative risk associated with TRPCs in pediatric patients is reliant on further multiinstitutional studies powered to examine patterns and predictors of this highly morbid entity.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Lesão Pulmonar Aguda Relacionada à Transfusão/epidemiologia , Adolescente , Fatores Etários , Perda Sanguínea Cirúrgica/mortalidade , Transfusão de Sangue/mortalidade , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Minnesota/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/mortalidade , Fatores de Tempo , Lesão Pulmonar Aguda Relacionada à Transfusão/diagnóstico , Lesão Pulmonar Aguda Relacionada à Transfusão/mortalidade , Lesão Pulmonar Aguda Relacionada à Transfusão/terapia , Resultado do Tratamento
11.
Chirurgia (Bucur) ; 113(2): 218-226, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29733010

RESUMO

Background: Emergency general surgery patients are at significant risk of postoperative complications and mortality compared with their elective counterparts. Although challenged by some studies, increasing evidence shows that emergency colectomy for cancer is associated with worse early postoperative and long-term outcomes. Methods: We have included all patients with colon cancer admitted to the Emergency Hospital of Bucharest between January 2011 and January 2016. SELECTION CRITERIA: (1) colon tumor; (2) left-sided localization of the tumor; (3) pathology exam revealing adenocarcinoma. EXCLUSION CRITERIA: (1) rectal cancers; (2) benign pathology (e.g. diverticulitis). Results: We included 615 patients with left-sided colon cancer. 275 (44.7%) patients presented complicated disease. The complication was represented by obstruction in 205 (33.3%) patients (OG), hemorrhage in 55 (8.9%) patients (HG), and perforation in 15 (2.4%) patients (PG). The anastomotic leakage rate was similar between obstructive and elective cases (6.2% versus 6.5%, P 0.05), but was significantly higher for hemorrhagic patients (16%) (P=0.046). The 30-day complication rate and mortality were significantly higher in emergency patients (P 0.05). Conclusions: We found significant worse short- and long-term outcomes for patients with nonelective left-sided colon cancer resections. Correlating the ominous prognosis with the high incidence of the complicated disease, we may emphasize the impact on de complicated colon cancer on the general population.


Assuntos
Adenocarcinoma/cirurgia , Colectomia , Colo Descendente/cirurgia , Neoplasias do Colo/cirurgia , Procedimentos Cirúrgicos Eletivos , Complicações Pós-Operatórias/etiologia , Adenocarcinoma/complicações , Adenocarcinoma/mortalidade , Idoso , Fístula Anastomótica/etiologia , Perda Sanguínea Cirúrgica/mortalidade , Colectomia/efeitos adversos , Colectomia/mortalidade , Neoplasias do Colo/complicações , Neoplasias do Colo/mortalidade , Procedimentos Cirúrgicos Eletivos/métodos , Emergências , Feminino , Humanos , Obstrução Intestinal/etiologia , Perfuração Intestinal/etiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
12.
J Cardiovasc Surg (Torino) ; 59(5): 729-736, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29616523

RESUMO

BACKGROUND: Although bloodless cardiac surgery has been successfully performed for many years, studies with controls permitting transfusion are few and their results inconclusive. This study compares the outcome of cardiac surgery on Jehovah's Witnesses (JW) refusing transfusion, with that of controls permitting transfusion if required. METHODS: Data from 172 operations in 162 JW were compared with 172 matched controls. Risk factors, preoperative, operative, 48 hour postoperative variables, outcome data and transfusions were recorded. RESULTS: Preoperative and operative variables were similar in both groups except for more previous cardiac operations, and more frequent use of cell saver and aprotinin in JW, who bled less and had higher hemoglobin concentrations at all periods. Thirty-day mortality was higher in JW (9.9% vs. 3.5%; P=0.03) (Risk difference 6.4%; CI95%: 2.7-10.1). Nevertheless operative mortality was similar in both groups (9.9% vs. 7.6%; P=0.44). Mortality in low-risk subjects was higher in JW (8.9% vs. 1.0%; P=0.02) (Risk difference 7.9%; CI95%: 2.7-13.2). Moreover, death associated with hemorrhage and anemia tended to be more frequent in JW. Mortality of transfused controls (14.1%) and their matched JW (13.0%) was similar. In contrast, mortality of non-transfused controls was zero versus 6.3% in their matched JW (P=0.059). CONCLUSIONS: Low-risk JW had significantly higher mortality than controls. Bleeding related deaths tended to be more frequent in JW. Blood-sparing maneuvers should be intensively implemented in both JW and patients permitting transfusion in order to reduce bleeding and the need for transfusion with its harmful effects.


Assuntos
Transfusão de Sangue , Procedimentos Médicos e Cirúrgicos de Sangue , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar , Testemunhas de Jeová , Recusa do Paciente ao Tratamento , Idoso , Perda Sanguínea Cirúrgica/mortalidade , Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Médicos e Cirúrgicos de Sangue/efeitos adversos , Procedimentos Médicos e Cirúrgicos de Sangue/mortalidade , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/prevenção & controle , Religião e Medicina , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
J Am Heart Assoc ; 7(5)2018 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-29502105

RESUMO

BACKGROUND: There is still uncertainty about the safety of aprotinin for coronary artery bypass graft surgery. The ART (Arterial Revascularization Trial) was designed to compare survival after bilateral versus single internal thoracic artery grafting. Many of the ART patients (≈30%) received perioperative aprotinin. We investigated the association between perioperative aprotinin administration and short-term (in-hospital) and long-term outcomes by performing a post hoc analysis of the ART. METHODS AND RESULTS: Among patients enrolled in the ART (n=3102) from 2004 to 2007, we excluded those who did not undergo surgery (n=18) and those with no information about use of perioperative aprotinin (n=9). Finally, 836 of 3076 patients (27%) received aprotinin. Propensity matching was used to select 536 pairs for final comparison. Aprotinin was also associated with an increased risk of hospital mortality (9 [1.7%] versus 1 [0.2%]; odds ratio, 9.12; 95% confidence interval [CI], 1.15-72.2; P=0.03), intra-aortic balloon pump insertion (37 [6.9%] versus 17 [3.2%]; odds ratio, 2.26; 95% CI, 1.26-4.07; P=0.006), and acute kidney injury (102 [19.0%] versus 76 [14.2%]; odds ratio, 1.42; 95% CI, 1.03-1.97; P=0.03). Aprotinin was not associated with a lower incidence of transfusion (37 [6.9%] versus 28 [5.2%]; odds ratio, 1.34; 95% CI, 0.81-2.23; P=0.25) and reexploration (26 [4.9%] versus 19 [3.5%]; hazard ratio, 1.39; 95% CI, 0.76-2.53; P=0.28). At 5 years, all-cause mortality was significantly increased in the aprotinin group (56 [10.6%] versus 38 [7.3%]; hazard ratio, 1.51; 95% CI, 1.0-2.28; P=0.045). CONCLUSIONS: In the present post hoc ART analysis, aprotinin was associated with a significantly increased risk of early and late mortality. CLINICAL TRIAL REGISTRATION: URL: http://www.isrctn.com. Unique identifier: ISRCTN46552265.


Assuntos
Aprotinina/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Hemostáticos/administração & dosagem , Assistência Perioperatória/métodos , Hemorragia Pós-Operatória/prevenção & controle , Idoso , Aprotinina/efeitos adversos , Perda Sanguínea Cirúrgica/mortalidade , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/mortalidade , Esquema de Medicação , Feminino , Hemostáticos/efeitos adversos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Assistência Perioperatória/efeitos adversos , Assistência Perioperatória/mortalidade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
Anesthesiology ; 129(6): 1092-1100, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29543629

RESUMO

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Research into major bleeding during cardiac surgery is challenging due to variability in how it is scored. Two consensus-based clinical scores for major bleeding: the Universal definition of perioperative bleeding and the European Coronary Artery Bypass Graft (E-CABG) bleeding severity grade, were compared in this substudy of the Transfusion Avoidance in Cardiac Surgery (TACS) trial. METHODS: As part of TACS, 7,402 patients underwent cardiac surgery at 12 hospitals from 2014 to 2015. We examined content validity by comparing scored items, construct validity by examining associations with redo and complex procedures, and criterion validity by examining 28-day in-hospital mortality risk across bleeding severity categories. Hierarchical logistic regression models were constructed that incorporated important predictors and categories of bleeding. RESULTS: E-CABG and Universal scores were correlated (Spearman ρ = 0.78, P < 0.0001), but E-CABG classified 910 (12.4%) patients as having more severe bleeding, whereas the Universal score classified 1,729 (23.8%) as more severe. Higher E-CABG and Universal scores were observed in redo and complex procedures. Increasing E-CABG and Universal scores were associated with increased mortality in unadjusted and adjusted analyses. Regression model discrimination based on predictors of perioperative mortality increased with additional inclusion of the Universal score (c-statistic increase from 0.83 to 0.91) or E-CABG (c-statistic increase from 0.83 to 0.92). When other major postoperative complications were added to these models, the association between Universal or E-CABG bleeding with mortality remained. CONCLUSIONS: Although each offers different advantages, both the Universal score and E-CABG performed well in the validity assessments, supporting their use as outcome measures in clinical trials.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Ponte de Artéria Coronária/estatística & dados numéricos , Período Perioperatório/estatística & dados numéricos , Hemorragia Pós-Operatória/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/mortalidade , Transfusão de Sangue/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ponte de Artéria Coronária/efeitos adversos , Europa (Continente) , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório/mortalidade , Hemorragia Pós-Operatória/mortalidade , Valor Preditivo dos Testes , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Reprodutibilidade dos Testes , Fatores de Risco , Terminologia como Assunto
15.
J Cardiothorac Vasc Anesth ; 32(4): 1627-1634, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29174746

RESUMO

OBJECTIVES: The authors stopped using tranexamic acid (TXA) in April 2013. The present study aimed to examine the impact of a "no-TXA-use" policy by comparing the adverse effects of TXA and clinical outcomes before and after the policy change in patients undergoing cardiovascular surgery. DESIGN: A single center retrospective cohort study. SETTING: A single cardiovascular center. PARTICIPANTS: Patients undergoing cardiovascular surgery between January 2008 and July 2015 (n = 3,535). INTERVENTIONS: Patients' outcomes before and after the policy change were compared to evaluate the effects of the change. MEASUREMENTS AND MAIN RESULTS: The seizure rate decreased significantly after the policy change (6.9% v 2.7%, p < 0.001). However, transfusion volumes and blood loss volumes increased significantly after the policy change (1,840 mL v 2,030 mL, p = 0.001; 1,250 mL v 1,372 mL, p < 0.001, respectively). Thirty-day mortality was not statistically different (1.6% v 1.4%, p = 0.82), nor were any of the other outcomes. Propensity-matched analysis and segmented regression analysis showed similar results. CONCLUSIONS: The mortality rate remained the same even though the seizure rate decreased after the policy change. Blood loss volume and transfusion volume both increased after the policy change. TXA use provides an advantageous benefit by reducing the need for blood transfusion.


Assuntos
Antifibrinolíticos/efeitos adversos , Perda Sanguínea Cirúrgica/mortalidade , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/mortalidade , Ácido Tranexâmico/efeitos adversos , Idoso , Procedimentos Cirúrgicos Cardiovasculares/tendências , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Estudos Retrospectivos
16.
Reg Anesth Pain Med ; 43(1): 25-35, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29095750

RESUMO

BACKGROUND AND OBJECTIVES: Amputations of the lower extremity remain a common procedure in a high-risk population. Perioperative morbidity and mortality reach as high as 14.1% in below-knee amputations. We aimed to determine whether regional, or neuraxial, anesthesia, when compared with general anesthesia (GA), would be associated with reduced perioperative morbidity and mortality. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program data set. The study population was divided into 2 groups: patients undergoing regional anesthesia (RA) and those undergoing GA. The primary end point for our study was 30-day mortality. The secondary end points were return to the operating room, surgical site infections, pulmonary complications, acute kidney injury, urinary tract infection, cardiac arrest, myocardial infarction, perioperative transfusions, thromboembolisms, sepsis, composite measure of postoperative complications, and days from operation to discharge. RESULTS: Twelve thousand seven hundred twenty-three patients were identified. Older patients, white patients, patients with a higher body mass index, patients without dyspnea, patients with independent functional status, smokers, patients with sepsis, and patients with bleeding disorders were associated with receiving GA. Hispanic patients, patients with chronic obstructive pulmonary disease, and patients with congestive heart failure were associated with receiving RA. Our study did not reveal a 30-day mortality difference between RA and GA. Regional anesthesia was associated with a significantly decreased need for perioperative blood transfusions (11.8% vs 16.5%, P < 0.001) and a decrease in the composite measure of postoperative complications (25.7% vs 29.1%, P < 0.04). CONCLUSIONS: Regional anesthesia does not offer a mortality advantage over GA, but RA may reduce the need for perioperative blood transfusions.


Assuntos
Amputação/métodos , Anestesia por Condução/métodos , Anestesia Geral , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Pé/cirurgia , Perna (Membro)/cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Amputação/mortalidade , Anestesia por Condução/efeitos adversos , Anestesia por Condução/mortalidade , Anestesia Geral/efeitos adversos , Anestesia Geral/mortalidade , Perda Sanguínea Cirúrgica/mortalidade , Transfusão de Sangue/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
17.
EuroIntervention ; 13(15): e1841-e1849, 2018 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-28988157

RESUMO

AIMS: The aim of this study was to determine the prognostic significance of periprocedural bleeding based on various definitions on 30-day and one-year all-cause mortality in patients undergoing routine or urgent percutaneous coronary intervention (PCI). METHODS AND RESULTS: In this exploratory analysis of 25,107 patients enrolled in the three phase-3 CHAMPION trials, we assessed the prognostic impact of four bleeding scales (GUSTO, TIMI, ACUITY, and BARC) at 48 hrs. Follow-up all-cause mortality data were available at 30 days in all three trials, and at one year in CHAMPION PCI and CHAMPION PLATFORM. Bleeding rates within 48 hrs of PCI were variably identified by each clinical definition (range: <0.5% to >3.5%). Severe/major bleeding, measured by all bleeding scales, and blood transfusion requirement were independently associated with increased mortality at 30 days and one year after PCI (p<0.001 for all associations). Mild/minor bleeding was not independently predictive of one-year mortality (p>0.07 for all associations). Each bleeding definition demonstrated only modest ability to discriminate 30-day and one-year mortality (adjusted C-statistics range: 0.49 to 0.67). CONCLUSIONS: Commonly employed clinical definitions variably identify rates of bleeding after PCI. Severe or major, but not mild or minor, bleeding is independently associated with increased 30-day and one-year mortality. These data may aid in selection of appropriate bleeding metrics in future clinical trials.


Assuntos
Perda Sanguínea Cirúrgica/mortalidade , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/mortalidade , Hemorragia Pós-Operatória/mortalidade , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/mortalidade , Ensaios Clínicos Fase III como Assunto , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas/administração & dosagem , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Anticancer Res ; 37(10): 5863-5870, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28982913

RESUMO

BACKGROUND/AIM: Perioperative red blood cell transfusion (RBCT) can negatively affect the host's immune system. We investigated the effects of perioperative RBCT on long-term survival among patients with pancreatic ductal adenocarcinoma (PDAC). PATIENTS AND METHODS: We retrospectively evaluated 148 patients with PDAC who underwent surgery with curative intent (33 who received RBCTs and 115 who did not). Significant prognostic variables on univariate analysis were subjected to multivariate analyses using a Cox proportional hazard regression model. RESULTS: Both groups exhibited significant differences in age, preoperative haemoglobin levels, carbohydrate antigen 19-9 levels, maximum tumour size, tumour staging, operative time, intraoperative blood loss, major vascular resection, and the proportion of pancreaticoduodenectomies performed. Patients who underwent RBCTs exhibited significantly poorer overall survival (p<0.001) and recurrence-free survival (p<0.001) compared to patients who did not. CONCLUSION: Perioperative RBCT was associated with poorer long-term survival among patients with PDAC who underwent surgery with curative intent.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Carcinoma Ductal Pancreático/cirurgia , Transfusão de Eritrócitos/mortalidade , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/mortalidade , Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/patologia , Progressão da Doença , Intervalo Livre de Doença , Transfusão de Eritrócitos/efeitos adversos , Feminino , Humanos , Cuidados Intraoperatórios , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/efeitos adversos , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
Vestn Otorinolaringol ; 82(4): 19-21, 2017.
Artigo em Russo | MEDLINE | ID: mdl-28980589

RESUMO

The objective of the present study was to analyze the complications of tracheostomy associated with bleeding from the brachiocephalic trunk. A total of 13 protocols of the autopsy study of the patients who had died in the intensive care unit were available for the analysis. These patients had experienced heavy external bleeding from the tracheostomy defect shortly before death. The study has demonstrated that all the victims had the tracheostomy hole localized below the level of the standard dissection of the tracheal rings. Nine patients presented with a damage to the brachiocephalic trunk while four others had a pressure injury to the blood vessels. The study included the elucidation of the possible relationship between the anthropometric characteristics of the patients and the variability of the passage of the brachiocephalic trunk in front of the trachea. The length of the neck was found to usually correlate with the length of the body and the brachiocephalic trunk to run in front of the trachea at the level of its 8th-11th rings. The results of the present study may be instrumental in reducing the risk of complications after tracheostomy.


Assuntos
Perda Sanguínea Cirúrgica/mortalidade , Tronco Braquiocefálico/lesões , Complicações Intraoperatórias , Hemorragia Pós-Operatória , Traqueia/irrigação sanguínea , Traqueostomia , Lesões do Sistema Vascular , Adulto , Autopsia , Feminino , Humanos , Doença Iatrogênica/prevenção & controle , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Masculino , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Respiração Artificial/métodos , Traqueostomia/efeitos adversos , Traqueostomia/métodos , Traqueostomia/mortalidade , Falha de Tratamento , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/mortalidade
20.
Artigo em Inglês | MEDLINE | ID: mdl-28855222

RESUMO

BACKGROUND: Practice patterns in anticoagulant strategies used during percutaneous coronary intervention (PCI) in the United States for patients with non-ST-segment-elevation myocardial infarction and the comparative outcomes between bivalirudin and unfractionated heparin (UFH) have not been well described. METHODS AND RESULTS: Trends in anticoagulant use were examined among 553 562 PCIs performed by 9254 operators at 1538 hospitals for non-ST-segment-elevation myocardial infarction from 2009 to 2014 within the CathPCI Registry. To compare bivalirudin with UFH, propensity score matching and instrumental variable (IV) methods with operator preference for bivalirudin as the instrument were used. To determine whether differences in outcomes were because of differences in glycoprotein IIb/IIIa inhibitor (GPI) use, a test of mediation was performed using the IV. Outcomes were in-hospital bleeding and mortality. Bivalirudin use increased from 2009 to 2013 but declined during 2014. GPI use was 50.5% during UFH PCIs and 12.0% during bivalirudin PCIs. Before GPI adjustment, bleeding reductions with bivalirudin ranged from 2.04% (IV: 95% confidence interval [CI]: 1.81%, 2.27%) to 2.29% (propensity score: 95% CI: 2.14%, 2.44%) and mortality reductions ranged from 0.16% (IV: 95% CI: 0.03%, 0.28%) to 0.25% (propensity score: 95% CI: 0.17%, 0.33%). After GPI adjustment in the IV, more than half the bleeding reduction with bivalirudin was because of the lower use of GPIs (risk difference, -0.84%; 95% CI: -1.11%, -0.57%), and no survival benefit was apparent (risk difference, -0.10%; 95% CI: -0.24%, 0.05%). Bleeding reductions with bivalirudin were largest for transfemoral PCI (GPI-adjusted risk difference, -1.11%; 95% CI: -1.43%, -0.80%) and negligible for transradial PCI (GPI-adjusted risk difference, 0.09%; 95% CI: -0.32%, 0.50%). CONCLUSIONS: In the largest comparative analysis of bivalirudin versus UFH for non-ST-segment-elevation myocardial infarction to date, bivalirudin was associated with lower in-hospital bleeding and mortality given current practices with respect to GPI use and access site. Bleeding differences were, in part, explained by the greater use of GPIs with UFH. Reductions in bleeding were largest among those undergoing transfemoral PCI, whereas no bleeding benefit was observed for those treated with transradial PCI.


Assuntos
Perda Sanguínea Cirúrgica/mortalidade , Hirudinas/administração & dosagem , Pacientes Internados , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Fragmentos de Peptídeos/administração & dosagem , Intervenção Coronária Percutânea , Hemorragia Pós-Operatória/epidemiologia , Padrões de Prática Médica , Idoso , Antitrombinas/administração & dosagem , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Proteínas Recombinantes/administração & dosagem , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Estados Unidos/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA