Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding

Fremes, Stephen E.; Bi, Wong; Lee, Eric; R, Mai; Gt, Christakis; Rf, McLean; Bs, Goldman; Cd, Naylor

doi:10.1016/0003-4975(94)91636-5

Cited by 226 publications

(99 citation statements)

References 31 publications

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“…Moreover, a few direct comparison studies [56,57] and a metaanalysis [58] on blood-saving agents in cardiac surgery have shown that other nontransfusional hemostatic agents such as aprotinin, tranexamic acid, and e-aminocaproic acid are more effective than DDAVP. There are few clinical trials evaluating the prophylactic use of DDAVP in noncardiac surgery.…”

Section: Desmopressin In Patients Without Preexisting Bleeding Disordersmentioning

confidence: 99%

The use of desmopressin as a hemostatic agent: A concise review

Franchini

2007

American J Hematol

124

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Desmopressin, a synthetic derivative of the antidiuretic hormone vasopressin, is the treatment of choice for most patients with von Willebrand disease and mild hemophilia A. Moreover, the compound has been shown to be useful in a variety of inherited and acquired hemorrhagic conditions, including some congenital platelet function defects, chronic liver disease, uremia, and hemostatic defects induced by the therapeutic use of antithrombotic drugs such as aspirin and ticlopidine. Finally, desmopressin has been used as a blood saving agent in patients undergoing operations characterized by large blood loss and transfusion requirements, but studies suggest that this is not as effective as other methods. This review briefly summarizes the current clinical indications on the use of desmopressin as a hemostatic agent. Am. J. Hematol., 2007. © 2007 Wiley‐Liss, Inc.

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Section: Desmopressin In Patients Without Preexisting Bleeding Disordersmentioning

confidence: 99%

The use of desmopressin as a hemostatic agent: A concise review

Franchini

2007

American J Hematol

124

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“…In patients without a platelet hemostatic defect, the prophylactic administration of DDAVP to improve hemostasis after cardiac surgery has been studied, and the results are summarized in 3 meta-analyses, indicating no benefit. [469][470][471] Furthermore the clinical practice guidelines produced by the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists do not recommend the prophylactic use of DDAVP. 472 A randomized, prospective trial in children undergoing cardiac surgery also failed to identify a benefit for the prophylactic use of DDAVP.…”

Section: Prevention and Treatment Of Postoperative Coagulopathymentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

284

245

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“…Em quatro horas, 80% do fármaco já foi eliminado. A aprotinina teve o seu emprego comprovado como fármaco poupador de sangue em vários ensaios clínicos com distribuição aleatória de pacientes e três metanálises [33][34][35] . Inclusive em pacientes com alto risco para sangramento, a aprotinina demonstrou ser efetiva para reduzir sangramento e transfusões em cirurgia cardíaca com CEC [36][37][38] .…”

Section: Aprotininaunclassified

“…In 4 hours, 80% of the drug has already been eliminated. The use of aprotinin as a blood-sparing drug has been demonstrated in several clinical studies, with random distribution of patients, and 3 meta-analyses [33][34][35] . It has been demonstrated that aprotinin is effective in reducing bleeding and blood transfusions in cardiac surgeries with CPB, even in patients with increased risk of bleeding [36][37][38] .…”

Section: Aprotininmentioning

confidence: 99%

Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

Santos¹,

Splettstosser²,

Warpechowski³

et al. 2007

Rev. Bras. Anestesiol.

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RESUMOSantos ATL, Splettstosser JC, Warpechowski P, Gaidzinski MMPAntifibrinolíticos e Cirurgia Cardíaca com Circulação Extracorpórea. JUSTIFICATIVA E OBJETIVOS:A cirurgia cardíaca é a especialidade cirúrgica que com mais freqüência está associada a sangramento, coagulopatia e necessidade de derivados de sangue. Os agentes farmacológicos aprotinina, ácido epsilon-aminocapróico e ácido tranexâmico são os mais utilizados para auxiliar na hemostasia dos pacientes submetidos à circulação extracorpórea. O objetivo deste trabalho foi apresentar a fisiopatologia do sangramento em cirurgia cardíaca e a atual situação dos antifibrinolíticos quanto à sua eficácia e complicações quando usados nesses procedimentos, dando maior ênfase ao ácido tranexâmico e à aprotinina. CONTEÚDO:São discutidos os mecanismos pelos quais a circulação extracorpórea provoca alteração na hemostasia e de que maneira os antifibrinolíticos agem para diminuir o sangramento e o uso de sangue alogênico em cirurgia cardíaca. É dada ênfase ao problema do tromboembolismo que pode ocorrer com o emprego desses antifibrinolíticos, com revisão da literatura. CONCLUSÃO:A fibrinólise é um dos principais fatores relacionados com o aumento do sangramento em cirurgia cardíaca com circulação extracorpórea. A inibição da fibrinólise, juntamente com a preservação da função plaquetária, é, provavelmente, o mecanismo pelo qual os antifibrinolíticos diminuem o sangramento. O emprego desses fármacos reduz o sangramento em cirurgia cardíaca com circulação extracorpórea num percentual que pode chegar a 50%. Com relação à preocupação com o tromboembolismo, os áci-dos tranexâmico e epsilon-aminocapróico são opções que oferecem maior segurança que a aprotinina.Unitermos: CIRURGIA, Cardíaca: circulação extracorpórea, DRO-GAS, Antifibrinolíticos: aprotinina, ácido epsilon-aminocapróico, áci-do tranexâmico; SANGUE: coagulação. SUMMARYSantos ATL, Splettstosser JC, Warpechowski P, Gaidzinski MMPAntifibrinolytics and Cardiac Surgery with Cardiopulmonary Bypass. BACKGROUND AND OBJECTIVES:Cardiac surgery is the surgical subspecialty most often associated with bleeding, bleeding disorders, and the need of blood products. Agents such as aprotinin, episilon-aminocaproic acid, and tranexamic acid are frequently used to aid the hemostasis of patients undergoing cardiopulmonary bypass. The objective of this report is to present the physiopathology of bleeding during cardiac surgeries and the current role of antifibrinolytics regarding their efficacy and complications when used in those procedures, with emphasis on tranexamic acid and aprotinin. CONTENTS:The mechanisms of changes in hemostasis caused by cardiopulmonary bypass, how antifibrinolytics decrease bleeding, and the use of alogenic blood in cardiac surgery are discussed. A review of the literature emphasizes the thromboembolism secondary to the use of those antifibrinolytics. CONCLUSION:Fibrinolysis is one of the main factors related with increased bleeding during cardiac surgery with cardiopulmonary bypass. Inhibition of fibrinol...

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Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding

Cited by 226 publications

References 31 publications

The use of desmopressin as a hemostatic agent: A concise review

The use of desmopressin as a hemostatic agent: A concise review

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

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