OBJECTIVES:Acute kidney injury is associated with many conditions, and no interventions to improve the outcomes of established acute kidney injury have been developed. We performed this study to determine whether goal-directed therapy conducted during the early stages of acute kidney injury could change the course of the disease.METHODS:This was a multicenter prospective randomized controlled study. Patients with early acute kidney injury in the critical care unit were randomly allocated to a standard care (control) group or a goal-directed therapy group with 8h of intensive treatment to maximize oxygen delivery, and all patients were evaluated during a period of 72h. ClinicalTrials.gov: NCT02414906.RESULTS:A total of 143 patients were eligible for the study, and 99 patients were randomized. Central venous oxygen saturation was significantly increased and the serum lactate level significantly was decreased from baseline levels in the goal-directed therapy group (p=0.001) compared to the control group (p=0.572). No significant differences in the change in serum creatinine level (p=0.96), persistence of acute kidney injury beyond 72h (p=0.064) or the need for renal replacement therapy (p=0.82) were observed between the two groups. In-hospital mortality was significantly lower in the goal-directed therapy group than in the control group (33% vs. 51%; RR: 0.61, 95% CI: 0.37-1.00, p=0.048, number needed to treat=5).CONCLUSIONS:Goal-directed therapy for patients in the early stages of acute kidney injury did not change the disease course.
to post procedural transfusion were heart failure, diabetes and peripheral arterial disease. Increase INR level and activated partial thromboplastin time (aPTT) are both significantly correlated to complication development (p<0.05). The types of medications that are significantly correlated to post procedural transfusion included Unfractionated Heparin (p=0.009), Clopidogrel (p=0.041) and GP2B3A inhibitor (p=0.039). Prasugrel (p=0.001) and Bivalirudin were the only medications that significantly did not show an increase in the need for transfusion. The antiplatelet Aspirin (p>0.05) and low molecular weight (LMW) Heparin (p>0.05) were the only medications that did not show significant correlation to bleeding and transfusion. Conclusions: Practitioners should take into consideration the patient's age ≥70, female sex, low BMI, coagulation status (elevated INR and aPTT level) and concomitant use of anticoagulant as a basis when prescribing anticoagulant therapy among patients undergoing cardiac interventional procedures
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