Abstract:Purpose
The rate of postoperative morbidity, including infectious complications, is still high after major hepatobiliary pancreatic (HBP) surgery. Although surgery-related disseminated intravascular coagulation (DIC) occurs in some cases, its significance has not been elucidated in HBP surgery. This study aimed to evaluate the influence of surgery-related DIC on the complication severity after HBP surgery.
Methods
We analyzed the records of 100 pat… Show more
“…We speculate that the group requiring transfusion of all three types of blood products included a larger number of patients with DIC than did the group requiring transfusion of one or two types of blood products; moreover, the survival benefit seen in the NM group might be associated with the DIC treatment effects of NM. Both the higher transfusion requirements in surgical compared to medical patients and the stronger benefit of NM over NA in surgical patients strengthen the likelihood of DIC as a link between NM and improved patient outcomes, considering that surgery itself can cause DIC [ 36 ]. This speculation was supported by a study by Kamijo et al [ 37 ] who used data from the nationwide retrospective DIC registry in Japan (J-Septic DIC registry) to evaluate the in-hospital and in-ICU mortality of patients with sepsis who underwent blood purification in the ICU.…”
Background: Continuous kidney replacement therapy (CKRT) is crucial in the management of acute kidney injury in intensive care units (ICUs). Nonetheless, the optimal anticoagulation strategy for patients with bleeding tendencies remains debated. This study aimed to evaluate patient outcomes and safety of nafamostat mesylate (NM) compared with no anticoagulation (NA) in critically ill patients with bleeding tendencies who were undergoing CKRT. Methods: This retrospective study enrolled 2,313 patients who underwent CKRT between March 2013 and December 2022 at the third affiliated hospital in South Korea. After applying the exclusion criteria, 490 patients were included in the final analysis, with 245 patients in the NM and NA groups each, following 1:1 propensity score matching. Subsequently, in-hospital mortality, incidence of bleeding complications, agranulocytosis, hyperkalemia, and length of hospital stay were assessed. Results: No significant differences were observed between the groups regarding the lengths of hospital and ICU stays or the incidence of agranulocytosis and hyperkalemia. The NM group showed a smaller decrease in hemoglobin levels during CKRT (–1.90 g/dL vs. –2.39 g/dL) and less need for blood product transfusions than the NA group. Furthermore, the NM group exhibited a survival benefit in patients who required transfusion of all three blood products. Conclusion: NM is an effective and safe anticoagulant for CKRT in critically ill patients, especially those requiring transfusion of all three blood products. Although these findings are promising, further multicenter studies are needed to validate them and explore the mechanisms underlying the observed benefits.
“…We speculate that the group requiring transfusion of all three types of blood products included a larger number of patients with DIC than did the group requiring transfusion of one or two types of blood products; moreover, the survival benefit seen in the NM group might be associated with the DIC treatment effects of NM. Both the higher transfusion requirements in surgical compared to medical patients and the stronger benefit of NM over NA in surgical patients strengthen the likelihood of DIC as a link between NM and improved patient outcomes, considering that surgery itself can cause DIC [ 36 ]. This speculation was supported by a study by Kamijo et al [ 37 ] who used data from the nationwide retrospective DIC registry in Japan (J-Septic DIC registry) to evaluate the in-hospital and in-ICU mortality of patients with sepsis who underwent blood purification in the ICU.…”
Background: Continuous kidney replacement therapy (CKRT) is crucial in the management of acute kidney injury in intensive care units (ICUs). Nonetheless, the optimal anticoagulation strategy for patients with bleeding tendencies remains debated. This study aimed to evaluate patient outcomes and safety of nafamostat mesylate (NM) compared with no anticoagulation (NA) in critically ill patients with bleeding tendencies who were undergoing CKRT. Methods: This retrospective study enrolled 2,313 patients who underwent CKRT between March 2013 and December 2022 at the third affiliated hospital in South Korea. After applying the exclusion criteria, 490 patients were included in the final analysis, with 245 patients in the NM and NA groups each, following 1:1 propensity score matching. Subsequently, in-hospital mortality, incidence of bleeding complications, agranulocytosis, hyperkalemia, and length of hospital stay were assessed. Results: No significant differences were observed between the groups regarding the lengths of hospital and ICU stays or the incidence of agranulocytosis and hyperkalemia. The NM group showed a smaller decrease in hemoglobin levels during CKRT (–1.90 g/dL vs. –2.39 g/dL) and less need for blood product transfusions than the NA group. Furthermore, the NM group exhibited a survival benefit in patients who required transfusion of all three blood products. Conclusion: NM is an effective and safe anticoagulant for CKRT in critically ill patients, especially those requiring transfusion of all three blood products. Although these findings are promising, further multicenter studies are needed to validate them and explore the mechanisms underlying the observed benefits.
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.
