scholarly journals Seizures following cardiac surgery: the impact of tranexamic acid and other risk factors

2011 ◽  
Vol 59 (1) ◽  
pp. 6-13 ◽  
Author(s):  
Rizwan A. Manji ◽  
Hilary P. Grocott ◽  
Jill Leake ◽  
Rob E. Ariano ◽  
Jacqueline S. Manji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Tranexamic Acid ◽  
The Impact

P1395The role of hyponatremia in the development of atrial fibrillation after cardiac surgery

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Pavlikova ◽  
A Shevelyok ◽  
N Vatutin
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Serum Sodium ◽  
Sodium Level ◽  
Cox Regression ◽  
Serum Sodium Level ◽  
History Of ◽  
The Impact

Abstract Background. Atrial fibrillation (AF) is one of the most common complication after cardiac surgeries. Age, valvular heart disease, heart failure, chronic obstructive pulmonary disease and a history of AF are well known risk factors for postoperative AF. On the other hand, hyponatremia is also a frequent disorder in patients undergoing cardiac surgery but its relationship with AF has not been studied. Purpose. We evaluated the impact of hyponatremia on the incidence of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods. The retrospective study included case history of 222 patients (174 men and 48 women, median age 64.5 [range 58.0; 69.0] years) who underwent cardiac surgery with cardiopulmonary bypass between January 2015 and December 2018.  In all patients intraoperative sodium level was analyzed. Hyponatremia was defined as serum sodium level < 135 mmol/l. Primary outcome was the episode of AF in postoperative period. Results. The incidence of postoperative AF was 18.9% (95% confidence interval (CI) 14.1-24.3 P = 0.05). Patients with AF more often had obesity, diabetes mellitus and a history of myocardial infarction and were more likely to perform combined surgery compared to non-AF patients (all Ps < 0.05). The prevalence of hyponatremia was significantly higher among AF group compared with non-AF (95.2% versus 77.8%, P = 0.017). Hyponatremia was the independent risk factors of postoperative AF in Cox regression models adjusted for covariates (odds ratio 5.31; 95% CI 1.42-18.7; P = 0.017). Conclusion.  In this analysis serum sodium level was closely associated with the risk of AF. These findings suggest that hyponatremia may cause the development of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass.

Warfarin-Induced Rapid Rise in INR Post–Cardiac Surgery Is Not Associated With Increased Bleeding Risk

2019 ◽  
Vol 53 (12) ◽  
pp. 1184-1191 ◽  
Author(s):  
Logan M. Olson ◽  
Andrea M. Nei ◽  
Ross A. Dierkhising ◽  
David L. Joyce ◽  
Scott D. Nei
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Warfarin Dose ◽  
Retrospective Chart Review ◽  
Female Gender ◽  
Bleeding Risk ◽  
Hospital Length Of Stay ◽  
Rapid Rise ◽  
The Impact ◽  
Post Cardiac Surgery

Background: Post–cardiac surgery bleeding can have devastating consequences, and it is unknown if warfarin-induced rapid international normalized ratio (INR) rise during the immediate postoperative period increases bleed risk. Objective: To determine the impact of warfarin-induced rapid-rise INR on post–cardiac surgery bleeding. Methods: This was a single-center, retrospective chart review of post–cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester. Patients were grouped based on occurrence or absence of rapid-rise INR (increase ≥1.0 within 24 hours). The primary outcome compared bleed events between groups. Secondary outcomes assessed hospital length of stay (LOS) and identified risk factors associated with bleed events and rapid rise in INR. Results: During the study period, 2342 patients were included, and 56 bleed events were evaluated. Bleed events were similar between rapid-rise (n = 752) and non–rapid-rise (n = 1590) groups in both univariate (hazard ratio [HR] = 1.22; P = 0.594) and multivariable models (HR = 1.24; P = 0.561). Those with rapid-rise INR had longer LOS after warfarin administration (discharge HR = 0.84; P = 0.0002). The most common warfarin dose immediately prior to rapid rise was 5 mg. Risk factors for rapid-rise INR were low body mass index, female gender, and cross-clamp time. Conclusion and Relevance: This represents the first report to assess warfarin-related rapid-rise INR in post–cardiac surgery patients and found correlation to hospital LOS but not bleed events. Conservative warfarin dosing may be warranted until further research can be conducted.

Incidence and Risk Factors for Thrombosis in Patients with Acute Promyelocytic Leukemia. Experience of the PETHEMA LPA96 and LPA99 Protocols.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1503-1503 ◽  
Author(s):  
Pau Montesinos ◽  
Javier de la Serna ◽  
Edo Vellenga ◽  
Consuelo Rayon ◽  
Juan Bergua ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tranexamic Acid ◽  
Acute Promyelocytic Leukemia ◽  
Univariate Analysis ◽  
Promyelocytic Leukemia ◽  
Cerebral Stroke ◽  
Flt3 Mutations ◽  
The Impact ◽  
Ischemic Events

Abstract Background: Thrombo-ischemic events can be a severe complication in patients with active acute promyelocytic leukemia (APL). In a recently published study, the incidence of thrombosis among 90 patients with APL was 9%, and it was related to CD2 surface antigen expression, FLT3 mutations and leukocytes >10×109/L. The introduction of coagulopathy prophylaxis with tranexamic acid has not shown a benefit on hemorrhagic mortality, but its impact on the incidence of thrombotic events is unclear. Objectives:Analyze the incidence and risk factors for the development of thrombosis in patients with APL undergoing induction chemotherapy.Analyze the impact of prophylaxis with tranexamic acid on development of thrombosis. Material and methods: Between 1996 and 2005 759 patients with newly diagnosed APL were registered in the multicenter PETHEMA LPA96 and LPA99 trials. Twenty-six patients (3.5%) died due to complications before start of chemotherapy (CT). Induction consisted of ATRA plus idarubicin. In the LPA99 trial prophylactic tranexamic acid 100 mg/kg/day was introduced in case of platelets <50×109/L. At the end of the LPA99 trial its use was not recommended, and overall, initiation of tranexamic acid was reported in 257 patients (35%) We performed a univariate analysis to assess clinico-biological factors associated with thrombosis. Significant variables (p<0.05) were included in a multivariate analysis. Results: 39/759 patients (5.1%) developed thrombosis. Among 26 patients who died before initiation of CT, 6 (23%) presented with thrombotic complications: 3 cerebral stroke (CNS), 2 pulmonary embolism (PE) and 1 acute myocardial infarction (AMI). Thirty-three (4.5%) of the 733 patients in whom CT was initiated experienced thrombosis: 3 at diagnosis (1 AMI, 1 CNS and 1 deep venous thrombosis (DVT)) and 30 after the start of CT (16 DVT, 6 CNS, 3 PE, 2 AMI and 2 others). Four thrombotic events were related with initiation of tranexamic acid: 2 DVT, 1 skin necrosis and 1 renal necrosis. The following factors were related to a higher incidence of thrombosis: leukocytes >10×109/L (9% vs 4%, p<0.01), M3-variant subtype (11% vs 4%, p=0.02), fibrinogen <170 mg/dl (7% vs 3%, p=0.02) and hemoglobin >10 g/dl (8% vs 4%, p=0.03). No significant relation was observed with CD2 or other surface antigens, as well as FLT3 mutations. Use of tranexamic acid showed a trend towards a higher incidence of thrombosis (6% vs 3%, p=0.08). In multivariate analysis hypofibrinogenemia and M3-v subtype remained as independent prognostic factors. Thrombosis was related with a higher induction mortality (including deaths before start of CT), 28% vs 11%, p<0.01. Conclusion: Thrombo-ischemic events are relatively frequent in active APL patients implying an elevated early mortality. Hypofibrinogenemia and M3-v are associated with a higher incidence of thrombosis. Treatment with tranexamic acid has not decreased hemorrhagic mortality and it could be related to increased thrombotic events. Therefore its prophylactic use should not be recommended.

Tissue Factor and Platelet Glycoprotein Ib-α Alleles Are Associated with Age at First Coronary Bypass Operation

2003 ◽  
Vol 99 (6) ◽  
pp. 1287-1294 ◽  
Author(s):  
Brian S. Donahue ◽  
Daniel W. Byrne ◽  
David Gailani ◽  
Alfred L. George
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Tissue Factor ◽  
Multivariate Regression ◽  
Coronary Bypass ◽  
Platelet Glycoprotein ◽  
Glycoprotein Ib ◽  
Younger Age ◽  
Traditional Risk Factors ◽  
The Impact

Background Age is a known risk factor for postoperative complications, but the genetic factors that account for variability in age at presentation for surgery have not been characterized. Because thrombosis is a critical process in the development of coronary syndromes, the authors hypothesized that patients bearing the -1208 insertion allele of tissue factor (TF) and longer glycoprotein Ib-alpha (GpIbalpha) variants may come to surgical attention sooner and undergo coronary artery bypass grafting (CABG) at a younger age. The authors tested this hypothesis in a cardiac surgery population. Methods The impact of the number of TF -1208 insertion alleles and the number of GpIbalpha repeats on age at first CABG were tested in 424 elective coronary bypass patients. Multivariate regression included traditional risk factors of sex, hypertension, diabetes, hyperlipidemia, and smoking. The authors also tested the hypothesis that these alleles are correlated with age at first noncoronary cardiac surgery in a group of 143 patients undergoing noncoronary cardiac operations. Result Both the number of TF -1208 insertion alleles and total number of GpIbalpha repeats were associated with younger age at first CABG in a univariate analysis. In multivariate regression in which traditional risk factors were included, the number of TF -1208 insertion alleles and the total number of GpIbalpha repeats were independent contributors toward age at first CABG. Neither polymorphism had a significant impact on age at first noncoronary cardiac surgery. Conclusions Genetic variants in TF and GpIbalpha are associated with younger age at first CABG, indicating that the younger and older first-time CABG populations are different on the genetic level. How these genetic differences may account for age-associated differences in perioperative risk will be the subject of future investigations.

scholarly journals Pažintinių funkcijų sutrikimai po kardiochirurginių operacijų: intraoperacinių veiksnių įtaka

2008 ◽  
Vol 6 (2) ◽  
pp. 0-0 ◽  
Author(s):  
Ieva Norkienė ◽  
Juozas Ivaškevičius
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Cognitive Decline ◽  
Surgical Intervention ◽  
Early Postoperative Period ◽  
Adverse Outcomes ◽  
Cerebral Hypoperfusion ◽  
Neurocognitive Outcomes ◽  
The Impact

Ieva Norkienė, Juozas IvaškevičiusVilniaus universiteto Anesteziologijos ir reanimatologijos klinika,Vilniaus greitosios pagalbos universitetinė ligoninė, Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected] Šiuolaikinėje širdies chirurgijoje prioritetu tampa ne tik paciento gyvybės išsaugojimas, bet ir sveikatos grąžinimas. Pooperaciniu laikotarpiu pacientų sveikimą ir grįžimą prie įprastinio gyvenimo ritmo, net jei fizinė savijauta gera, dažnai sunkina rečiau ir sunkiau diagnozuojamos neuropsichologinės komplikacijos. Pažintinių (kognityvinių) funkcijų sutrikimai, arba kognityvinė disfunkcija, įvairių autorių duomenimis, gali būti nustatoma net iki 53% pacientų ankstyvuoju pooperaciniu laikotarpiu, o praėjus keleriems metams išlieka apie 20% gydytų ligonių. Ieškant efektyviausių būdų neurologinėms komplikacijoms išvengti, šiuolaikinėje medicinos literatūroje aktyviai svarstoma, kokią įtaką šiai patologinei būklei rastis turi intraoperaciniai veiksniai. Straipsnyje apžvelgiama dirbtinės kraujo apytakos, embolizacijos, hipoperfuzijos ir anestezijos sąsaja su pažintinių funkcijų pokyčiais po kardiochirurginių operacijų. Pagrindiniai žodžiai: pažintinių funkcijų sutrikimai, kardiochirurgija, rizikos veiksniai Cognitive decline after cardiac surgery: the impact of intraoperative factors Ieva Norkienė, Juozas IvaškevičiusClinic of Anesthesiology and Intensive Care of Vilnius UniversityEmergency Hospital, Šiltnamių 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] The quality of postoperative life becomes one of the most important aspects in assessing the outcomes of any surgical intervention. Recovery from the immediate effects of cardiac surgery is often complicated by less noticeable and hardly diagnosed neuropsychological complications. According to various authors, cognitive decline occurs in up to 53% of patients in the early postoperative period and persists in 20% of patients for a couple of years after surgery. Recent studies suggest that the incidence of these adverse outcomes may be closely related to intraoperative factors. In the present paper, we discuss the influence of cardiopulmonary bypass, embolisation, cerebral hypoperfusion and anesthesia on neurocognitive outcomes after cardiac surgery. Key words: cognitive decline, cardiac surgery, risk factors

scholarly journals Risk factors associated with postoperative seizures in patients undergoing cardiac surgery who received tranexamic acid: A case-control study

2012 ◽  
Vol 15 (1) ◽  
pp. 6 ◽  
Author(s):  
FelixR Montes ◽  
DanielF Pardo ◽  
Marisol Carreño ◽  
Catalina Arciniegas ◽  
RodolfoJ Dennis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Tranexamic Acid ◽  
Case Control Study ◽  
Case Control ◽  
Factors Associated ◽  
Control Study

Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome

Perfusion ◽  
2020 ◽  
Vol 35 (8) ◽  
pp. 756-762 ◽  
Author(s):  
Matteo Matteucci ◽  
Sandro Ferrarese ◽  
Cristiano Cantore ◽  
Giangiuseppe Cappabianca ◽  
Giulio Massimi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Lactate ◽  
Surgical Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Arterial Blood ◽  
The Impact

Introduction: Lactate, a product of anaerobic metabolism, is a biomarker and indicator for tissue hypoperfusion and oxygen debt. An elevated blood lactate level has been associated with poor outcome in many clinical conditions, including cardiac surgery. Nevertheless, debate exists regarding which blood lactate concentration is most indicative of poor outcomes. We evaluate the impact of hyperlactatemia, defined as a peak arterial blood concentration ⩾2.0 mmol/L during cardiopulmonary bypass, on surgical results with a focus on long-term outcome. Methods: We reviewed 1,099 consecutive adult patients who underwent cardiac surgery on pump. The patients were divided into two groups based on the presence or not of hyperlactatemia. Pre- and intraoperative risk factors for hyperlactatemia were identified, and the postoperative outcome of patients with or without hyperlactatemia was compared. Results: Hyperlactatemia was present in 372 patients (33.8%). Factors independently associated with hyperlactatemia were urgent/emergency procedure, cardiopulmonary bypass duration and aortic cross-clamp time. Patients with hyperlactatemia had significantly higher rate of prolonged mechanical ventilation time, in-hospital stay and requirement of inotropes and intra-aortic balloon pump support (p < 0.001). Operative (30-day) mortality was higher in the group of patients with hyperlactatemia (7.8% vs. 1.1%; p < 0.001). Kaplan–Meier curve showed worse long-term survival (mean follow-up: 4.02 ± 1.58 years) in patients with hyperlactatemia. Conclusion: Hyperlactatemia during cardiopulmonary bypass has a significant association with postoperative morbidity and mortality. Correction of risk factors for hyperlactatemia, together with prompt detection and correction of this condition, may control complications and improve outcome.

scholarly journals 1232 Trust-Wide Assessment of Delirium in Post-Operative Elective Surgery

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Sundar ◽  
S Biggs ◽  
M Abraham ◽  
J Cook ◽  
N Watts ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Patient Outcomes ◽  
Assessment Tool ◽  
Elective Surgery ◽  
Outcome Data ◽  
Positive Screen ◽  
Acute Change ◽  
Delirium Management ◽  
The Impact

Abstract Aim Delirium is an acute change in cognition and associated with adverse patient outcomes. The incidence of post-operative delirium after elective non-cardiac surgery is unknown. We aimed to assess the incidence of post-operative delirium in this group and the effect on patient outcomes. Method Patients aged 65 and over who underwent elective non-cardiac surgery were identified on post-operative day three. Delirium screening was performed in real time using the validated 4-AT assessment tool. A retrospective review of the patients’ preoperative and perioperative record was conducted to collect demographics and identify risk factors for delirium. Outcome data was collected at 30 days. Patients with a positive delirium score (&gt;4) underwent a more in-depth assessment and managing teams given a delirium management pack. Results 75 (39 male) consecutive patients were screened over a period of 4 months. Median age 77 years and 18% had frailty assessed as “vulnerable”. The majority of patients (37.3%) underwent thoracic surgery, followed by hepatobiliary (17.3%), gynaecological (17.3%), colorectal (12%), maxillofacial (9.3%) and ENT (4%). 5.3% (4) of patients had a positive 4-AT screen. No patients had a formal delirium screen or diagnosis in the initial 48 hours. The median length of stay for patients with a positive screen was 8.5 days (IQR 7.5-12) compared to 8 days (IQR 5-13) for patients with a negative screen. Conclusions Reassuringly, rate of post-operative delirium following elective operations in our Trust are low (5%). Larger numbers of patients are required to assess the impact this has on patient outcomes and identify correlation with risk factors.

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