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1.
N Engl J Med ; 382(13): 1219-1231, 2020 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-32212518

RESUMO

BACKGROUND: Patients with transfusion-dependent ß-thalassemia need regular red-cell transfusions. Luspatercept, a recombinant fusion protein that binds to select transforming growth factor ß superfamily ligands, may enhance erythroid maturation and reduce the transfusion burden (the total number of red-cell units transfused) in such patients. METHODS: In this randomized, double-blind, phase 3 trial, we assigned, in a 2:1 ratio, adults with transfusion-dependent ß-thalassemia to receive best supportive care plus luspatercept (at a dose of 1.00 to 1.25 mg per kilogram of body weight) or placebo for at least 48 weeks. The primary end point was the percentage of patients who had a reduction in the transfusion burden of at least 33% from baseline during weeks 13 through 24 plus a reduction of at least 2 red-cell units over this 12-week interval. Other efficacy end points included reductions in the transfusion burden during any 12-week interval and results of iron studies. RESULTS: A total of 224 patients were assigned to the luspatercept group and 112 to the placebo group. Luspatercept or placebo was administered for a median of approximately 64 weeks in both groups. The percentage of patients who had a reduction in the transfusion burden of at least 33% from baseline during weeks 13 through 24 plus a reduction of at least 2 red-cell units over this 12-week interval was significantly greater in the luspatercept group than in the placebo group (21.4% vs. 4.5%, P<0.001). During any 12-week interval, the percentage of patients who had a reduction in transfusion burden of at least 33% was greater in the luspatercept group than in the placebo group (70.5% vs. 29.5%), as was the percentage of those who had a reduction of at least 50% (40.2% vs. 6.3%). The least-squares mean difference between the groups in serum ferritin levels at week 48 was -348 µg per liter (95% confidence interval, -517 to -179) in favor of luspatercept. Adverse events of transient bone pain, arthralgia, dizziness, hypertension, and hyperuricemia were more common with luspatercept than placebo. CONCLUSIONS: The percentage of patients with transfusion-dependent ß-thalassemia who had a reduction in transfusion burden was significantly greater in the luspatercept group than in the placebo group, and few adverse events led to the discontinuation of treatment. (Funded by Celgene and Acceleron Pharma; BELIEVE ClinicalTrials.gov number, NCT02604433; EudraCT number, 2015-003224-31.).


Assuntos
Receptores de Activinas Tipo II/uso terapêutico , Transfusão de Eritrócitos/estatística & dados numéricos , Hematínicos/uso terapêutico , Fragmentos Fc das Imunoglobulinas/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Talassemia beta/tratamento farmacológico , Receptores de Activinas Tipo II/efeitos adversos , Adolescente , Adulto , Idoso , Método Duplo-Cego , Feminino , Ferritinas/sangue , Hematínicos/efeitos adversos , Humanos , Fragmentos Fc das Imunoglobulinas/efeitos adversos , Análise de Intenção de Tratamento , Análise dos Mínimos Quadrados , Masculino , Pessoa de Meia-Idade , Razão de Chances , Proteínas Recombinantes de Fusão/efeitos adversos , Esplenectomia , Adulto Jovem , Talassemia beta/genética , Talassemia beta/cirurgia , Talassemia beta/terapia
2.
Kathmandu Univ Med J (KUMJ) ; 17(65): 20-24, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734673

RESUMO

Background Blood component are essential part of patient and hospital for the safety and improvement of health care of patient. Proper transfusion is must to avoid the misuse, overuse and transfusion reaction. Objective The main objective of this study was to provide information regarding current utility of blood component in tertiary care hospital of central Nepal. Method In this descriptive study, details of blood components transfused were recorded that was correlated with patient age, sex, different hospital wards, clinical diagnosis and pretransfusion hemoglobin for the duration of 6 month Result Total blood component utilize were 1,267 for 539 patients. Whole blood was most utilized blood component that is followed by packed red blood cells. Demand of Blood product was highest in patient admitted to Intensive Care Unit (ICU). Bleeding patients due to obstetric and gastrointestinal complication got maximum transfusion of blood component. Majorly transfusion of Whole Blood and Packed red cell was done for pre transfusion hemoglobin level that falls in 7 to 10 gm/dl. Conclusion Analysis of blood component usage in any hospital with blood bank setup is very important to improve the blood utilization pattern for transfusion and maintaining blood stock to meet the future demand of blood component.


Assuntos
Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Centros de Atenção Terciária , Transfusão de Sangue/estatística & dados numéricos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Hemoglobinas/análise , Hemorragia/terapia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Nepal , Gravidez
3.
Am Surg ; 85(11): 1246-1252, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775966

RESUMO

When endoscopy is performed for acute GI bleeding, therapeutic endoscopic procedures are infrequently required (only 6% of cases). We sought to determine the natural history of GI hemorrhage in patients who have undergone therapeutic endoscopy. We queried our hospital database for inpatients with acute GI bleeding who underwent therapeutic endoscopy between 2015 and 2017. The primary endpoints were recurrence of bleeding and the subsequent need for repeated endoscopic interventions, angioembolization, or surgery. Demographic information was collected. We reviewed 205 hospitalized patients: mean age was 70 years, 58 per cent were male, and mean hemoglobin was 9 g/dL. Patients had medical conditions predisposing them to bleeding in 59 per cent and history of previous GI bleeding in 37 per cent of cases. Sixty per cent were on antiplatelet/anticoagulation medications, and 10 per cent were receiving nonsteroidal anti-inflammatory medications. Blood transfusions were given to 78 per cent of patients, with an average of 2.3 units of packed red blood cells transfused per patient before intervention. Recurrence of hemorrhage after therapeutic endoscopy was seen in 9 per cent of patients. Only 2 per cent underwent a second therapeutic endoscopic procedure, and 5 per cent had surgery or angioembolization (half of these patients then had a further recurrence of bleeding). In total, seven patients died (3%). Recurrence of GI bleeding after therapeutic endoscopies is uncommon (9%). Surgery and angioembolization are not commonly necessary, but when used are only successful in 50 per cent of cases.


Assuntos
Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Anticoagulantes/uso terapêutico , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Hemorragia Gastrointestinal/sangue , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemoglobina A/análise , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Recidiva , Retratamento , Estudos Retrospectivos , Adulto Jovem
4.
Heart Surg Forum ; 22(5): E396-E400, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31596719

RESUMO

BACKGROUND: Cardiovascular surgery is associated with substantial risk for postoperative bleeding with increased patient morbidity and mortality. Numerous intraoperative techniques have been utilized to reduce this risk. This study was to assess postoperative bleeding-related parameters following Bentall procedures and to examine the impact of intraoperative surgical sealant application. METHOD: The medical/surgical records of 100 consecutive Bentall procedure cases were examined retrospectively for perioperative surgical sealant use and postoperative bleeding-related outcomes. RESULTS: Of the 100 patient cases, three died during the postoperative period, and 97 were evaluable. Surgical sealant was utilized in 56 patient cases (57.8%). The utilization versus no utilization of surgical sealant was associated with significant reductions in most postoperative bleeding-related parameters, including less drainage (P = .028), resternotomy for hemorrhage (P = .036), transfusion of red blood cells (P = .022 at 48 hours; P = .027 total in-hospital), transfusion of fresh frozen plasma (P = .04 at 48 hours; P = .004 total in-hospital), and a higher percentage of cases not needing blood transfusion (P = .002). The surgical sealant group had longer cardiopulmonary bypass circuit (P = .016) and aortic cross-clamp time (P = .001), with no significant between-group differences in intubation time (P = .636) or intensive care unit duration (P = .294). When excluding urgent cases or Stanford type A aortic dissections, intensive care unit duration significantly was shorter in the surgical sealant group (P = .017). Surgical sealant use was not associated with any adverse events. CONCLUSION: The application of surgical sealant to the anastomosis suture line in Bentall procedures reduces postoperative drainage, bleeding, and transfusion utilization. Further studies are warranted to investigate these benefits in prospective, randomized clinical trials.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Adesivo Tecidual de Fibrina/uso terapêutico , Hemorragia Pós-Operatória/prevenção & controle , Adesivos Teciduais/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Estudos de Coortes , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Drenagem/estatística & dados numéricos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Plasma , Reoperação , Estudos Retrospectivos , Esternotomia , Resultado do Tratamento
5.
BMC Palliat Care ; 18(1): 67, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387568

RESUMO

BACKGROUND: Palliative patients generally present with symptoms of dyspnea, easy fatigability, lethargy and feeling of being unwell which can broadly be attributed to one root cause: cancer-related anemia. So, packed red cell transfusion is often carried out aiming to improve patients' functional status. Different cut off hemoglobin values have been suggested, with Hb < 9 g/dL the most commonly accepted. The present study aims at evaluating and comparing the benefits in subjective symptoms of fatigue and breathlessness among transfused and non-transfused palliative patients on Day 0 and Day 7. METHODS: Hemoglobin values, anemia related subjective symptoms of fatigue and breathlessness were recorded from 122 patients. The patients were re-evaluated on day-7 post-transfusion. The pre and post-transfusion symptomatic benefit was compared in both transfused and non-transfused palliative care patients. RESULTS: The currently practiced hemoglobin trigger for packed red cell transfusion is 10 g/dL. The units of packed red cell to be transfused was decided according to the hemoglobin values targeting the rise to > 10 g/dL. A mean 1.36 units were transfused. Statistically significant improvement was observed in patient reported symptoms of fatigue and breathlessness among both transfused and non-transfused palliative patients. CONCLUSION: Anemic cancer palliative patients were found to benefit following packed red cell transfusion, suggesting a favorable association between the transfusion and patient-reported fatigue and dyspnea.


Assuntos
Transfusão de Eritrócitos/normas , Neoplasias/terapia , Cuidados Paliativos/normas , Adulto , Idoso , Dispneia/terapia , Transfusão de Eritrócitos/métodos , Transfusão de Eritrócitos/estatística & dados numéricos , Fadiga/terapia , Feminino , Hemoglobinas/análise , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nepal , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Cuidados Paliativos/métodos
6.
BMC Musculoskelet Disord ; 20(1): 304, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31248398

RESUMO

BACKGROUND: Geriatric hip fracture patients are particularly susceptible to blood loss and venous thromboembolism (VTE) during hemiarthroplasty, yet relatively few studies have examined the safety and efficacy of tranexamic acid (TXA) in these patients. METHODS: This cohort study of hip fracture patients (≥65 years) undergoing hemiarthroplasty between January 2013 and September 2016 involved 289 patients who received 15 mg/kg TXA prior to surgery and 320 who received no TXA. All patients underwent a fast-track program including nutrition, blood, and pain management; VTE prophylaxis; early mobilization; and early intake. The primary outcome was red cell transfusion requirement. Secondary outcomes included blood loss, hemoglobin (Hb) level, VTE, adverse events and length of hospital stay. Multivariate logistic regression and meta-analysis of the literature were also performed to control for confounding factors and identify risk factors of red cell transfusion. RESULTS: The proportion of patients receiving at least 1 U of erythrocytes was significantly lower in the TXA group (8.65%) than in the control group (24.06%, OR 0.299, p < 0.001). Mean Hb level was significantly higher in the TXA group on postoperative day 1 (111.70 ± 18.40 vs 107.29 ± 18.70 g/L, p = 0.008) and postoperative day 3 (108.16 ± 17.25 vs 104.22 ± 15.16 g/L, p = 0.005). A significantly higher proportion of TXA patients began to ambulate within 24 h after surgery (37.02% vs 26.25%, p = 0.004), and their length of hospitalization was significantly shorter (11.82 ± 4.39 vs 15.96 ± 7.30 days, p = 0.003). TXA did not increase risk of DVT (OR 0.70, 95%CI 0.25 to 1.97). Logistic regression showed that, after adjusting for covariates, TXA was associated with 62% lower risk of red blood cell transfusion (0.327, 95%CI 0.214 to 0.696), and a similar result was obtained in meta-analysis of unadjusted data from the present study and the literature (OR 0.33, 95%CI 0.25 to 0.43). CONCLUSION: TXA appears to be safe and effective for reducing blood loss and red blood cell transfusion in geriatric hip fracture patients undergoing fast-track hemiarthroplasty.


Assuntos
Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Hemiartroplastia/efeitos adversos , Fraturas do Quadril/cirurgia , Ácido Tranexâmico/administração & dosagem , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antifibrinolíticos/efeitos adversos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Injeções Intravenosas , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Ácido Tranexâmico/efeitos adversos , Resultado do Tratamento , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle
7.
Int J Gynaecol Obstet ; 146(2): 257-262, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31141161

RESUMO

OBJECTIVE: To determine the effect of a quality improvement and educational initiative on blood transfusion rates and patient morbidity from massive postpartum hemorrhage. METHODS: A retrospective chart review was performed of massive postpartum hemorrhage (mPPH) at an urban tertiary care center. Inclusion criteria are women with mPPH over 20 weeks gestational age. The primary outcome was the number of packed red blood cell (pRBC) transfusions required. Two time periods were compared-the control period (January 2006-December 2011), and the educational period (January 2012-December 2015) by calculating an incidence rate ratio using Poisson regression. RESULTS: Among 189 women with mPPH, 107 cases occurred during the control period and 82 during the educational period. In the educational period, there were 13% (95% confidence interval [CI] 2%-23%) fewer pRBC and 16% (95% CI 1%-29%) fewer fresh frozen plasma (FFP) units transfused compared with the control period. There was a decrease of 58 minutes (95% CI -106 to -9.52) of the median time from diagnosis of mPPH to transfusion of FFP. CONCLUSION: The quality improvement educational initiative decreased the number of pRBC and FFP transfusions required, and shortened the latency interval to transfusion of FFP.


Assuntos
Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Transfusão de Eritrócitos/estatística & dados numéricos , Hemorragia Pós-Parto/terapia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Plasma , Gravidez , Melhoria de Qualidade , Estudos Retrospectivos
8.
Clinics (Sao Paulo) ; 74: e652, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31038643

RESUMO

OBJECTIVES: Thirty to sixty percent of prepared blood products are not transfused. Blood reserves for surgeries lead to many unused blood products, which increases hospital costs. The aim of this study is to identify the request and use profiles of blood products for elective surgeries in different surgical specialties, the influence of surgery time and demographic, clinical, and laboratory variables on the number of red blood cells (RBCs) used and to calculate the rate of transfused patients (RTP) and cross-matched and transfused (C/T) RBCs. METHODS: Observational and prospective studies. Sociodemographic, clinical and quantitative data on the request and use of blood products were collected. The influence of the data on the use of RBCs was examined by binary logistic regression. Chi-square, one-way ANOVA and Kruskal-Wallis tests were utilized to compare the data among the specialties. RESULTS: In total, 822 procedures were included. Most of the requested blood products were not used, even 24 hours postoperatively. Of the 2,483 RBC units, 314 were transfused, leaving 87.6% unused; however, cardiac, digestive tract, vascular, gynecologic, urologic and thoracic surgery procedures transfused 50%, 25%, 16.5%, 11%, 9.5% and 8.1% of requested RBCs, respectively. The factors that influenced the transfusions were age, time of surgery and cardiac surgeries. The RTP was >10% in 22 surgical types and <1% in 24 surgical types, and 88% of samples presented a C/T ratio >2.5. CONCLUSION: The RTP and C/T ratios can guide RBC requests in the preoperative period. Knowing the standard of use of blood products and developing protocols enables the optimization of reserves, reduction of costs and improvement of care.


Assuntos
Transfusão de Sangue , Procedimentos Cirúrgicos Eletivos , Transfusão de Eritrócitos/métodos , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos , Transfusão de Eritrócitos/estatística & dados numéricos , Eritrócitos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Prospectivos , Estatística como Assunto , Fatores de Tempo
9.
Lancet ; 393(10187): 2201-2212, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31036337

RESUMO

BACKGROUND: Anaemia and iron deficiency are frequent in patients scheduled for cardiac surgery. This study assessed whether immediate preoperative treatment could result in reduced perioperative red blood cell (RBC) transfusions and improved outcome. METHODS: In this single-centre, randomised, double-blind, parallel-group controlled study, patients undergoing elective cardiac surgery with anaemia (n=253; haemoglobin concentration (Hb) <120 g/L in women and Hb <130 g/L in men) or isolated iron deficiency (n=252; ferritin <100 mcg/L, no anaemia) were enrolled. Participants were randomly assigned (1:1) with the use of a computer-generated range minimisation (allocation probability 0·8) to receive either placebo or combination treatment consisting of a slow infusion of 20 mg/kg ferric carboxymaltose, 40 000 U subcutaneous erythropoietin alpha, 1 mg subcutaneous vitamin B12, and 5 mg oral folic acid or placebo on the day before surgery. Primary outcome was the number of RBC transfusions during the first 7 days. This trial is registered with ClinicalTrials.gov, number NCT02031289. FINDINGS: Between Jan 9, 2014, and July 19, 2017, 1006 patients were enrolled; 505 with anaemia or isolated iron deficiency and 501 in the registry. The combination treatment significantly reduced RBC transfusions from a median of one unit in the placebo group (IQR 0-3) to zero units in the treatment group (0-2, during the first 7 days (odds ratio 0·70 [95% CI 0·50-0·98] for each threshold of number of RBC transfusions, p=0·036) and until postoperative day 90 (p=0·018). Despite fewer RBC units transfused, patients in the treatment group had a higher haemoglobin concentration, higher reticulocyte count, and a higher reticulocyte haemoglobin content during the first 7 days (p≤0·001). Combined allogeneic transfusions were less in the treatment group (0 [IQR 0-2]) versus the placebo group (1 [0-3]) during the first 7 days (p=0·038) and until postoperative day 90 (p=0·019). 73 (30%) serious adverse events were reported in the treatment group group versus 79 (33%) in the placebo group. INTERPRETATION: An ultra-short-term combination treatment with intravenous iron, subcutaneous erythropoietin alpha, vitamin B12, and oral folic acid reduced RBC and total allogeneic blood product transfusions in patients with preoperative anaemia or isolated iron deficiency undergoing elective cardiac surgery. FUNDING: Vifor Pharma and Swiss Foundation for Anaesthesia Research.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Eritropoetina/administração & dosagem , Compostos Férricos/administração & dosagem , Ácido Fólico/administração & dosagem , Maltose/análogos & derivados , Cuidados Pré-Operatórios/métodos , Vitamina B 12/administração & dosagem , Administração Intravenosa , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/complicações , Procedimentos Cirúrgicos Cardíacos , Método Duplo-Cego , Quimioterapia Combinada , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Cardiopatias/complicações , Cardiopatias/cirurgia , Humanos , Masculino , Maltose/administração & dosagem , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
10.
Plast Reconstr Surg ; 143(5): 1109e-1117e, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033841

RESUMO

BACKGROUND: This study described the prevalence of bleeding complications necessitating blood transfusion across plastic surgery procedures and identified those procedures that may be associated with higher rates of bleeding. METHODS: The authors retrospectively identified patients who suffered from postoperative bleeding complications from 2010 to 2015 using the National Surgical Quality Improvement Program database. This is defined by the National Surgical Quality Improvement Program as the need for transfusion of at least one unit of packed or whole red blood cells. Patient characteristics were described using summary statistics, and National Surgical Quality Improvement Program and univariate analysis of patient characteristics and bleeding complications was performed. RESULTS: Overall, 1955 of 95,687 patients experienced bleeding complications. Patients with bleeding complications were more likely to be diagnosed with hypertension, have a longer total operative time, and have a previously diagnosed bleeding disorder. The most common primary plastic surgery procedure associated with bleeding complications was breast reconstruction with a free flap, and breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap had the highest rate of bleeding. A return to the operating room was required in 539 patients (27.6 percent) who suffered a postoperative bleeding complication. Patients with a preexisting bleeding disorder [n = 1407 (1.5 percent)] were more likely to be diabetic, have a lower preoperative hematocrit, and have a longer operative time. In addition, these patients were more likely to suffer from other nonbleeding complications (1.29 percent versus 0.35 percent; p < 0.01). CONCLUSIONS: Complex procedures (i.e., free flap breast reconstruction) have a higher prevalence of bleeding requiring a transfusion. Furthermore, patients undergoing combined procedures-specifically, breast oncologic and reconstructive cases-may be at a higher risk for experiencing bleeding-related complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Transfusão de Eritrócitos/estatística & dados numéricos , Mamoplastia/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adulto , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Mamoplastia/métodos , Pessoa de Meia-Idade , Duração da Cirurgia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Prevalência , Melhoria de Qualidade/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos
11.
Innovations (Phila) ; 14(2): 134-143, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30885089

RESUMO

OBJECTIVE: Although the morbidity associated with red blood cell transfusion in cardiac surgery has been well described, the impacts of platelet transfusion are less clearly understood. Given the conflicting results of prior studies, we sought to investigate the impact of platelet transfusion on outcomes after cardiac surgery across institutions in Maryland. METHODS: Using a multiinstitutional statewide database created by the Maryland Cardiac Surgery Quality Initiative, we retrospectively analyzed data from 10,478 patients undergoing isolated coronary artery bypass across 10 centers. Platelet transfusion practices were compared between institutions. Multivariate logistic regression model was used to analyze the association between platelet transfusion and 30-day mortality and postoperative complications. RESULTS: Rates of platelet transfusion varied between institutions from 4.4% to 24.7% ( P < 0.001), a difference that remained statistically significant in propensity score-matched cohorts. Among patients on preoperative antiplatelet therapy, transfusion rates varied from 8.5% to 46.4% ( P < 0.001). There was no statistically significant relationship between case volume and transfusion rates ( P = 0.815). In multivariate logistic regression, platelet transfusion was associated with increased risk of 30-day mortality (OR 2.43, P = 0.008), postoperative pneumonia (OR 2.21, P = 0.004), prolonged intubation (OR 2.05, P < 0.001), and readmission (OR 1.43, P = 0.039). CONCLUSIONS: Significant variation existed in platelet transfusion rates between institutions, even after controlling for various risk factors. This variation may be associated with increased mortality and length of stay. Further study is warranted to better understand risks associated with platelet transfusion. Standardizing practice may help reduce risk and conserve resources.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ponte de Artéria Coronária/mortalidade , Transfusão de Eritrócitos/efeitos adversos , Transfusão de Plaquetas/efeitos adversos , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Transfusão de Eritrócitos/métodos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Mortalidade , Transfusão de Plaquetas/métodos , Transfusão de Plaquetas/tendências , Complicações Pós-Operatórias/etiologia , Melhoria de Qualidade/normas , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
12.
J Thorac Cardiovasc Surg ; 158(5): 1370-1379.e6, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30853233

RESUMO

OBJECTIVE: We sought to characterize the relationship between postoperative blood pressure on the day of surgery and metrics of bleeding. METHODS: In a preplanned secondary analysis of prospectively collected data from the Limiting IV Chloride to Reduce AKI trial (NCT02020538), univariate and multivariable regression analyses explored the association between peak systolic blood pressure, peak mean arterial pressure, and peak central venous pressure recorded postoperatively on the day of surgery and multiple metrics of bleeding. Patients at increased bleeding risk due to specific criteria were excluded from analysis. The primary outcome was chest tube drainage (milliliters per hour) on the day of surgery. Secondary outcomes included red blood cell transfusion, surgical re-exploration for bleeding, and hospital mortality. RESULTS: The study cohort comprised 793 patients. Mean ± standard deviation peak systolic blood pressure, mean arterial pressure, and central venous pressure were 125 ± 15 mm Hg, 83 ± 9 mm Hg, and 12 ± 4 mm Hg, respectively. Median (interquartile range) chest tube drainage on the day of surgery was 33 mL/hour (interquartile range, 23 mL/hour-51 mL/hour). Adjusted for prespecified variables, there was no positive association between peak systolic blood pressure and bleeding outcomes, including chest tube drainage (-2.2 mL/10 mm Hg; 95% confidence interval, -3.9 to -0.5 mL/h/10 mm Hg; P = .01) or volume of transfusion (-15 mL/10 mm Hg; 95% confidence interval, -29 to -1 mL/h/10 mm Hg; P = .04). Results remained broadly consistent across multiple secondary outcomes and regardless of whether systolic blood pressure or mean arterial pressure was the explanatory variable. CONCLUSIONS: The lack of positive association between peak systolic blood pressure or peak mean arterial pressure with metrics of bleeding after cardiac surgery promotes equipoise for testing the influence of higher blood pressure targets during the early postoperative period.


Assuntos
Pressão Arterial , Determinação da Pressão Arterial , Procedimentos Cirúrgicos Cardíacos , Pressão Venosa Central , Drenagem , Transfusão de Eritrócitos , Hemorragia Pós-Operatória , Austrália/epidemiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Tubos Torácicos , Drenagem/instrumentação , Drenagem/métodos , Transfusão de Eritrócitos/métodos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/fisiopatologia , Hemorragia Pós-Operatória/terapia
13.
Am J Hosp Palliat Care ; 36(8): 718-721, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30845809

RESUMO

BACKGROUND: Despite the increasing use of erythropoiesis-stimulating agent (ESA) in patients receiving dialysis, few studies have examined the benefits of ESA for patients with chronic kidney disease receiving palliative care. OBJECTIVE: We designed a retrospective observational study to evaluate the effect of ESA in treating anemia of renal disease among adult patients receiving palliative care instead of dialysis. The primary objective was to assess whether ESA can reduce the transfusion burden and hospitalization. RESULTS: Thirty-nine patients receiving ESA were matched with a control group of 39 patients without ESA. Their mean age and glomerular filtration rates were 76.7 (10.2) years and 11.6 (5.7) mL/min/1.73 m2, respectively. Baseline hemoglobin levels were comparable in the ESA and control groups; their corresponding values were 10.2 (1.5) and 10.1 (1.4) g/dL. During 1-year observation period, 34 units of red cell transfusion occurred in patients receiving ESA, whereas 128 units of red cell were transfused to patients in control group. Patients in the control group had higher transfusion rate (incidence rate ratio [IRR]: 3.63; 95% confidence interval [CI]: 2.49-5.31; P < .00001) and higher admission rates (IRR: 2.34; 95% CI: 1.80-3.03; P < .000001) than the ESA group even after adjustment for comorbidities. CONCLUSIONS: High disease burden of palliative care among patients with stage 4 to 5 chronic kidney disease was reflected by transfusion requirement and hospitalization rates, both of which were shown to be significantly ameliorated by ESA treatment.


Assuntos
Transfusão de Eritrócitos/estatística & dados numéricos , Hematínicos/uso terapêutico , Cuidados Paliativos/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/terapia , Masculino , Diálise Renal/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença
14.
Surgery ; 165(6): 1122-1127, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30871812

RESUMO

BACKGROUND: Women are underrepresented in trauma research, and aggregated results of clinical trials may mask effects that differ by sex. It is unclear whether women respond differently to severe hemorrhage compared with men. We sought to evaluate sex-based differences in outcomes after severe trauma with hemorrhage. METHODS: We performed a secondary analysis of the Pragmatic Randomized Optimal Platelet and Plasma Ratios trial. Trauma patients predicted to require massive transfusion were randomized to a 1:1:1 vs 1:1:2 plasma to platelet to red blood cell transfusion ratio. Analysis was performed according to sex, controlling for clinical characteristics and transfusion arm. RESULTS: A total of 134 women and 546 men were analyzed. In multivariable analysis, there was no difference in mortality at 24 hours (hazard ratio for women 0.64, 95% confidence interval 0.34-1.23, P = .18) or in time to hemostasis (hazard ratio 1.10, 95% confidence interval 0.84-1.42, P = .49) by sex. We observed no difference between sexes in volume of blood products transfused during active hemorrhage. However, after anatomic hemostasis, women received lower volumes of all products, with a 38% reduction in fresh frozen plasma (mean ratio 0.62 (95% confidence interval 0.43-0.89, P = .01), 49% reduction in platelets (mean ratio 0.51, 95% confidence interval 0.33-0.79, P < .01) and 49% reduction in volume of red blood cells (mean ratio 0.51, 95% confidence interval 0.33-0.79, P < .01). CONCLUSION: Mortality and time to hemostasis of trauma patients with hemorrhage did not differ by sex. Although there was no difference in transfusion requirement during active hemorrhage, once hemostasis was achieved, women received fewer units of all blood products than men. Further research is required to determine whether women exhibit differences in coagulation during and after severe traumatic hemorrhage.


Assuntos
Transfusão de Eritrócitos/estatística & dados numéricos , Hemorragia/terapia , Transfusão de Plaquetas/estatística & dados numéricos , Ressuscitação/métodos , Ferimentos e Lesões/complicações , Adulto , Feminino , Hemorragia/etiologia , Hemorragia/mortalidade , Técnicas Hemostáticas/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Ressuscitação/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Tempo para o Tratamento , Índices de Gravidade do Trauma , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Adulto Jovem
15.
Cochrane Database Syst Rev ; 2: CD004868, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30776084

RESUMO

BACKGROUND: Preterm infants have low plasma levels of erythropoietin (EPO), providing a rationale for the use of erythropoiesis-stimulating agents (ESAs) to prevent or treat anaemia. Darbepoetin (Darbe) and EPO are currently available ESAs. OBJECTIVES: To assess the effectiveness and safety of late initiation of ESAs, between eight and 28 days after birth, in reducing the use of red blood cell (RBC) transfusions in preterm or low birth weight infants. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), MEDLINE via PubMed (1966 to 5 June 2018), Embase (1980 to 5 June 2018), and CINAHL (1982 to 5 June 2018). We searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials of late initiation of EPO treatment (started at ≥ eight days of age) versus placebo or no intervention in preterm (< 37 weeks) or low birth weight (< 2500 grams) neonates. DATA COLLECTION AND ANALYSIS: We performed data collection and analyses in accordance with the methods of the Cochrane Neonatal Review Group. We used the GRADE approach to assess the quality of the evidence. MAIN RESULTS: We include 31 studies (32 comparisons) randomising 1651 preterm infants. Literature searches in 2018 identified one new study for inclusion. No new on-going trials were identified and no studies used darbepoetin.Most included trials were of small sample size. The meta-analysis showed a significant effect on the use of one or more RBC transfusions (21 studies (n = 1202); typical risk ratio (RR) 0.72, 95% confidence interval (CI) 0.65 to 0.79; typical risk difference (RD) -0.17, 95% CI -0.22 to -0.12; typical number needed to treat for an additional beneficial outcome (NNTB) 6, 95% CI 5 to 8). There was moderate heterogeneity for this outcome (RR I² = 66%; RD I² = 58%). The quality of the evidence was very low. We obtained similar results in secondary analyses based on different combinations of high/low doses of EPO and iron supplementation. There was no significant reduction in the total volume (mL/kg) of blood transfused per infant (typical mean difference (MD) -1.6 mL/kg, 95% CI -5.8 to 2.6); 5 studies, 197 infants). There was high heterogeneity for this outcome (I² = 92%). There was a significant reduction in the number of transfusions per infant (11 studies enrolling 817 infants; typical MD -0.22, 95% CI -0.38 to -0.06). There was high heterogeneity for this outcome (I² = 94%).Three studies including 404 infants reported on retinopathy of prematurity (ROP) (all stages or stage not reported), with a typical RR 1.27 (95% CI 0.99 to 1.64) and a typical RD of 0.09 (95% CI -0.00 to 0.18). There was high heterogeneity for this outcome for both RR (I² = 83%) and RD (I² = 82%). The quality of the evidence was very low.Three trials enrolling 442 infants reported on ROP (stage ≥ 3). The typical RR was 1.73 (95% CI 0.92 to 3.24) and the typical RD was 0.05 (95% CI -0.01 to 0.10). There was no heterogeneity for this outcome for RR (I² = 18%) but high heterogeneity for RD (I² = 79%). The quality of the evidence was very low.There were no significant differences in other clinical outcomes including mortality and necrotising enterocolitis. For the outcomes of mortality and necrotising enterocolitis, the quality of the evidence was moderate. Long-term neurodevelopmental outcomes were not reported. AUTHORS' CONCLUSIONS: Late administration of EPO reduces the use of one or more RBC transfusions, the number of RBC transfusions per infant (< 1 transfusion per infant) but not the total volume (mL/kg) of RBCs transfused per infant. Any donor exposure is likely not avoided as most studies included infants who had received RBC transfusions prior to trial entry. Late EPO does not significantly reduce or increase any clinically important adverse outcomes except for a trend in increased risk for ROP. Further research of the use of late EPO treatment, to prevent donor exposure, is not indicated. Research efforts should focus on limiting donor exposure during the first few days of life in sick neonates, when RBC requirements are most likely to be required and cannot be prevented by late EPO treatment. The use of satellite packs (dividing one unit of donor blood into many smaller aliquots) may reduce donor exposure.


Assuntos
Anemia Neonatal/prevenção & controle , Transfusão de Eritrócitos/estatística & dados numéricos , Eritropoetina/administração & dosagem , Hematínicos/administração & dosagem , Recém-Nascido de Baixo Peso/sangue , Recém-Nascido Prematuro/sangue , Fatores Etários , Displasia Broncopulmonar/etiologia , Causas de Morte , Esquema de Medicação , Eritropoetina/sangue , Mortalidade Hospitalar , Humanos , Recém-Nascido , Ensaios Clínicos Controlados Aleatórios como Assunto , Retinopatia da Prematuridade/etiologia , Fatores de Tempo
16.
Braz J Cardiovasc Surg ; 34(1): 33-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30810672

RESUMO

OBJECTIVE: To discover potentially modifiable perioperative predictors for renal replacement therapy (RRT) in patients with cardiac surgery-associated acute kidney injury (CSA-AKI). METHODS: A cohort of 1773 consecutive cardiac surgery patients with postoperative acute kidney injury (AKI) from January 2013 to December 2015 were included retrospectively. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary outcome was CSA-AKI requiring renal replacement therapy (AKI-RRT). The initiation of RRT was based on clinical judgment regarding severe volume overload, metabolic abnormality (e.g., acidosis, hyperkalemia), and oliguria. Patients with AKI-RRT were matched 1:1 with patients without AKI-RRT by a propensity score, to exclude the influence of patients' demographics, comorbidities, and baseline renal function. Multivariable regression was performed to identify the predictors in the matched sample. RESULTS: AKI-RRT occurred in 4.4% of the entire cohort (n=78/1773), with 28.2% of in-hospital mortality (n=22/78). With the propensity score, 78 pairs of patients were matched 1:1 and the variables found to be predictors of AKI-RRT included the contrast exposure within 3 days before surgery (odds ratio [OR]=2.932), central venous pressure (CVP) >10 mmHg on intensive care unit (ICU) admission (OR=1.646 per mmHg increase), and erythrocyte transfusions on the 1st day of surgery (OR=1.742 per unit increase). CONCLUSION: AKI-RRT is associated with high mortality. The potentially modifiable predictors found in this study require concern and interventions to prevent CSA-AKI patients from worsening prognosis.


Assuntos
Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Ponte de Artéria Coronária/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Terapia de Substituição Renal/estatística & dados numéricos , Medição de Risco/métodos , Idoso , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Período Perioperatório , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo
17.
Clin Perinatol ; 46(1): 101-117, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30771812

RESUMO

This article summarizes available evidence on the relationship between red blood cell transfusion and anemia, and necrotizing enterocolitis (NEC). We review recent studies that highlight the uncertainty of the effect of red blood cell transfusion on NEC and the potential role of anemia. We also discuss potential pathophysiologic effects of both red blood cell transfusion and anemia and highlight strategies to prevent anemia and red blood cell transfusion. We also discuss ongoing randomized trials that are likely to provide important new evidence to guide red blood cell transfusion practices.


Assuntos
Anemia/epidemiologia , Enterocolite Necrosante/epidemiologia , Transfusão de Eritrócitos/estatística & dados numéricos , Anemia/prevenção & controle , Anemia/terapia , Constrição , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Fatores de Risco , Cordão Umbilical
18.
Medicine (Baltimore) ; 98(5): e14219, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702577

RESUMO

Cardiac surgery under cardiopulmonary bypass (CPB) accounts for most consumption of red blood cells (RBCs). Identifying risk factors for massive red blood cell transfusion (MRT) in cardiac surgery may help to reduce this consumption.We retrospectively analyzed 8238 patients who underwent valve surgery and/or coronary artery bypass grafting (CABG) under CPB at 2 major heart centers in China. Uni- and multivariate logistic regression was carried out to assess whether risk factors for MRT (defined as receiving at least 4 units RBCs) varied with type of cardiac surgery.A total of 1691 patients (21%) received at least 4 units RBCs (6.77 ±â€Š4.78 units per person). This MRT group consumed 70% of the total units of allogeneic RBCs in the study. MRT incidence was 2-fold higher among patients undergoing CABG with or without valve surgery than among patients undergoing valve surgery alone. Multivariate logistic analysis identified the following MRT risk factors common to valve surgery alone, CABG alone, and their combination: female sex, older age, renal dysfunction, lower body mass index, lower preoperative hemoglobin, and longer CPB. Several independent MRT risk factors were also identified specific to valve surgery: active endocarditis, nonatrial fibrillation, smaller left atrium diameter, abnormal international normalized ratio, and repeat surgery.Different types of cardiac surgery share several, but not all, MRT risk factors. This study may help guide the prediction and management of patients at higher MRT risk.


Assuntos
Ponte de Artéria Coronária/estatística & dados numéricos , Transfusão de Eritrócitos/estatística & dados numéricos , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Fatores Etários , Índice de Massa Corporal , Comorbidade , Feminino , Hemoglobinas , Humanos , Testes de Função Renal , Modelos Logísticos , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
19.
Blood ; 133(12): 1279-1289, 2019 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-30617198

RESUMO

ß-thalassemia is a hereditary disorder with limited approved treatment options; patients experience anemia and its complications, including iron overload. The study aim was to determine whether luspatercept could improve anemia and disease complications in patients with ß-thalassemia. This open-label, nonrandomized, uncontrolled study consisted of a 24-week dose-finding and expansion stage (initial stage) and a 5-year extension stage, currently ongoing. Sixty-four patients were enrolled; 33 were non-transfusion dependent (mean hemoglobin, <10.0 g/dL; <4 red blood cell [RBC] units transfused per 8 weeks), and 31 were transfusion dependent (≥4 RBC units per 8 weeks). Patients received 0.2 to 1.25 mg/kg luspatercept subcutaneously every 21 days for ≥5 cycles (dose-finding stage) and 0.8 to 1.25 mg/kg (expansion cohort and 5-year extension). The primary end point was erythroid response, defined as hemoglobin increase of ≥1.5 g/dL from baseline for ≥14 consecutive days (without RBC transfusions) for non-transfusion-dependent patients or RBC transfusion burden reduction ≥20% over a 12-week period vs the 12 weeks before treatment for transfusion-dependent patients. Eighteen non-transfusion-dependent patients (58%) receiving higher dose levels of luspatercept (0.6-1.25 mg/kg) achieved mean hemoglobin increase ≥1.5 g/dL over ≥14 days vs baseline. Twenty-six (81%) transfusion-dependent patients achieved ≥20% reduction in RBC transfusion burden. The most common grade 1 to 2 adverse events were bone pain, headache, and myalgia. As of the cutoff, 33 patients remain on study. In this study, a high percentage of ß-thalassemia patients receiving luspatercept had hemoglobin or transfusion burden improvements. These findings support a randomized clinical trial to assess efficacy and safety. This study was registered at www.clinicaltrials.gov as #NCT01749540 and #NCT02268409.


Assuntos
Ativinas/uso terapêutico , Transfusão de Eritrócitos/estatística & dados numéricos , Hemoglobinas/análise , Fragmentos Fc das Imunoglobulinas/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Talassemia beta/tratamento farmacológico , Receptores de Activinas Tipo II , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
20.
Gynecol Oncol ; 153(1): 63-67, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30635213

RESUMO

OBJECTIVES: To determine whether perioperative red blood cell transfusion (PRBCT) affects infection, thrombosis, or survival rates in epithelial ovarian cancer (EOC) patients undergoing neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS). METHODS: Demographics, operative characteristics, and outcome data were abstracted from records of stage IIIC-IV EOC patients managed with NACT-IDS from 01/2010-07/2015. Associations of PRBCT with morbidity and oncologic outcomes were evaluated. RESULTS: Of 270 patients, 136 (50.4%) received PRBCT. Patients with preoperative anemia and higher estimated blood loss (EBL) were more likely to undergo PRBCT (OR,95%CI 1.80, 1.02-3.17) and (OR,95%CI 1.00, 1.002-1.004), respectively. There were no significant differences in PRBCT based on patient age, Charlson Comorbidity Index, or stage. When compared to low complexity operations, patients with moderate and high complexity surgeries were more likely to receive PRBCT (OR,95%CI 1.81, 1.05-3.09) and (OR,95%CI 2.25, 1.13-4.50), respectively. On univariate analysis, PRBCT was associated with intraabdominal infection (OR,95%CI 8.31, 1.03-67.41), but not wound complications (OR,95%CI 1.57, 0.76-3.23) or venous thromboembolism/pulmonary embolism (VTE/PE) (OR,95%CI 2.02, 0.49-8.23). After adjusting for surgical complexity and preoperative anemia, PRBCT was not independently associated with intraabdominal infection (OR,95%CI 7.66, 0.92-63.66), wound complications (OR,95%CI 1.70, 0.80-3.64), or VTE/PE (OR,95%CI 2.15, 0.51-9.09). When comparing patients undergoing PRBCT versus those who did not, there were no significant differences in median progression-free survival (PFS) or median overall survival (OS) on univariate analysis after adjusting for age, stage and residual disease. CONCLUSIONS: Among patients undergoing NACT-IDS, intraabdominal infection, wound complication and VTE/PE rates are similar, regardless of PRBCT. PRBCT does not impact PFS or OS.


Assuntos
Carcinoma Epitelial do Ovário/cirurgia , Procedimentos Cirúrgicos de Citorredução/estatística & dados numéricos , Transfusão de Eritrócitos/estatística & dados numéricos , Infecções Intra-Abdominais/epidemiologia , Embolia Pulmonar/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Tromboembolia Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Epitelial do Ovário/sangue , Carcinoma Epitelial do Ovário/tratamento farmacológico , Quimioterapia Adjuvante , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Infecções Intra-Abdominais/etiologia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Assistência Perioperatória/métodos , Assistência Perioperatória/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Intervalo Livre de Progressão , Embolia Pulmonar/genética , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Taxa de Sobrevida , Resultado do Tratamento , Tromboembolia Venosa/etiologia
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