Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to identify all the nonsurgical interventions, supported by randomized evidence, that may help reduce perioperative mortality
Background: Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes.Methods: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after surgery.
Results:The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P ¼ .27), and this did not significantly differ according to aspirin exposure at the time of surgery (interaction P ¼ .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P ¼ .053).
Conclusions:In this trial of patients having coronary artery surgery, tranexamic acid did not affect death or severe disability through to 1 year after surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.
This appears to be the first report of cluster-like headache secondary to post-traumatic subdural hematoma. A 39 year old man consulted us for cluster-like headáche on the right side following an injury to the right frontotemporal region some 45 days before. A CT scan revealed a chronic subdural hematoma in the right frontotemporal region. We discuss the possible relationship between the head injury and the headache and suggest the value of CT scanning in patients with cluster headache.
The frequency of prolonged muscular flaccidity (PMF) was examined in a series of stroke patients in chronic phase suffering from hemiplegia with minimal spontaneous recovery (MSR). The results indicated that in such a population with poor motor recovery, PMF was significantly more frequent than spasticity. PMF was found to be associated with left-sided hemiplegia and unilateral spatial neglect. The minimal spontaneous recovery of the series of stroke patients we studied could be dependent on the interaction of three negative prognostic factors: left sided hemiplegia, unilateral spatial neglect and prolonged muscular flaccidity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.