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Titolo:
Pharmacological strategies for blood conservation in cardiac surgery: erythropoietin and antifibrinolytics
Autore:
Hardy, JF;
Indirizzi:
CHUM, Hotel Dieu, Dept Anesthesiol, Montreal, PQ H2W 1T8, Canada CHUM Montreal PQ Canada H2W 1T8 Anesthesiol, Montreal, PQ H2W 1T8, Canada
Titolo Testata:
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
fascicolo: 4, volume: 48, anno: 2001, supplemento:, S
pagine: S24 - S31
SICI:
0832-610X(200104)48:4<S24:PSFBCI>2.0.ZU;2-B
Fonte:
ISI
Lingua:
ENG
Soggetto:
RECOMBINANT-HUMAN-ERYTHROPOIETIN; OPEN-HEART-SURGERY; ARTERY BYPASS-SURGERY; CARDIOPULMONARY BYPASS; TRANSFUSION PRACTICE; EPOETIN-BETA; APROTININ; METAANALYSIS; REQUIREMENTS; MULTICENTER;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
32
Recensione:
Indirizzi per estratti:
Indirizzo: Hardy, JF CHUM, Hotel Dieu, Dept Anesthesiol, Pavillon Bull,Local 6-521,3840 Rue St Urbain, Montreal, PQ H2W 1T8, Canada CHUM Pavillon Bull,Local 6-521,3840 Rue St Urbain Montreal PQ Canada H2W 1T8
Citazione:
J.F. Hardy, "Pharmacological strategies for blood conservation in cardiac surgery: erythropoietin and antifibrinolytics", CAN J ANAES, 48(4), 2001, pp. S24-S31

Abstract

Purpose: We review the clinically important benefits of the two principal pharmacological strategies, erythropoietin (EPO) and antifibrinolytics (aprotinin and lysine analogues), to decrease transfusion of allogeneic blood products (ABP) during and after cardiac surgery. Source: Articles were selected from an ongoing review of the literature, with special attention to meta-analyses dealing with EPO and/or antifibrinolytics and cardiac surgery. Principal findings: The few studies available include a number of patientsinsufficient to allow definitive conclusions on the benefits of EPO in cardiac surgery. Further studies are required to determine the optimal dose ofEPO and to compare its cost-effectiveness with other blood sparing strategies in this context. Both aprotinin and lysine analogues effectively decrease ABP transfusions and the incidence of re-thoracotomy, in addition. high-dose aprotinin reduces cerebrovascular morbidity and mortality after cardiopulmonary bypass. Several mechanisms have been put forward to explain these beneficial effects,some of which could well be common to all antifibrinolytic;. The clinical benefits of aprotinin's unique anti-inflammatory effect are not entirely clear but the finding that it reduces the incidence of stroke and death is certainly a major argument in favor of its utilization. Yet, we have to ensure that aprotinin's benefits are not offset by side-effects such as allergy. Conclusions: We still need large scale studies to definitely confirm the benefits and exclude the deleterious effects of these drugs on outcomes other than ABP requirements. At present, aprotinin is the only agent that has been shown to reduce the risk of cerebrovascular accident and mortality after cardiac surgery in adults.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 26/01/20 alle ore 16:54:42