Antifibrinolytic Therapy for Cardiac Surgery

2015 ◽  
Vol 123 (1) ◽  
pp. 214-221 ◽  
Author(s):  
Andreas Koster ◽  
David Faraoni ◽  
Jerrold H. Levy
Keyword(s):  
Cardiac Surgery ◽  
Side Effects ◽  
Tranexamic Acid ◽  
Chest Tube ◽  
Surgical Patients ◽  
Two Phase ◽  
Adverse Side Effects ◽  
Antifibrinolytic Therapy ◽  
Phase Ii Studies ◽  
New Compounds

Abstract Antifibrinolytic therapy reduces bleeding and chest tube drainage output in cardiac surgical patients but is associated with potential side effects. Two phase-II studies with new compounds were terminated prematurely. There is increasing evidence of adverse side effects with tranexamic acid.

Clinical descriptors of pneumothorax following chest tube removal in paediatric cardiac surgery

2020 ◽  
pp. 1-4
Author(s):  
Christine LaGrasta ◽  
Mary McLellan ◽  
Jean Connor
Keyword(s):  
Cardiac Surgery ◽  
Chest Radiograph ◽  
Chest Tube ◽  
Clinical Characteristics ◽  
Clinical Status ◽  
Surgical Patients ◽  
Paediatric Cardiac Surgery ◽  
Tube Removal ◽  
Chest Tube Removal ◽  
Clinically Significant

Abstract Background: There is limited data describing the characteristics of paediatric post-operative cardiac surgery patients who develop pneumothoraces after chest tube removal. Patient management after chest tube removal is not standardised across paediatric cardiac surgery programmes. The purposes of this study were to describe the frequency of pneumothorax after chest tube removal in paediatric post-operative cardiac surgical patients and to describe the patient and clinical characteristics of those patients who developed a clinically significant pneumothorax requiring intervention. Methods: A single-institution retrospective descriptive study (1 January, 2010–31 December, 2018) was utilised to review 11,651 paediatric post-operative cardiac surgical patients from newborn to 18 years old. Results: Twenty-five patients were diagnosed with a pneumothorax by chest radiograph following chest tube removal (0.2%). Of these 25 patients, 15 (1.6%) had a clinically significant pneumothorax and 8 (53%) did not demonstrate a change in baseline clinical status or require an increase in supplemental oxygen, 14 (93%) required an intervention, 9 (60%) were <1 year of age, 4 (27%) had single-ventricle physiology, and 5 (33%) had other non-cardiac anomalies/genetic syndromes. Conclusions: In our cohort of patients, we confirmed the incidence of pneumothorax after chest tube removal is low in paediatric post-operative cardiac surgery patients. This population does not always exhibit changes in clinical status despite having clinically significant pneumothoraces. We suggest the development of criteria, based on clinical characteristics, for patients who are at increased risk of developing a pneumothorax and would require a routine chest radiograph following chest tube removal.

scholarly journals Adverse side effects of dexamethasone in surgical patients

2018 ◽  
Author(s):  
Jorinde AW Polderman ◽  
Violet Farhang-Razi ◽  
Susan Van Dieren ◽  
Peter Kranke ◽  
J Hans DeVries ◽  
...  
Keyword(s):  
Side Effects ◽  
Surgical Patients ◽  
Adverse Side Effects

scholarly journals Adverse side effects of dexamethasone in surgical patients

2018 ◽  
Author(s):  
Jorinde AW Polderman ◽  
Violet Farhang-Razi ◽  
Susan Van Dieren ◽  
Peter Kranke ◽  
J Hans DeVries ◽  
...  
Keyword(s):  
Side Effects ◽  
Surgical Patients ◽  
Adverse Side Effects

Adverse side‐effects of dexamethasone in surgical patients – an abridged Cochrane systematic review

Anaesthesia ◽  
2019 ◽  
Vol 74 (7) ◽  
pp. 929-939 ◽  
Author(s):  
J. A. W. Polderman ◽  
V. Farhang‐Razi ◽  
S. Dieren ◽  
P. Kranke ◽  
J. H. DeVries ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Surgical Patients ◽  
Cochrane Systematic Review ◽  
Adverse Side Effects

scholarly journals Determining the Optimal Tranexamic Acid Dose for Cardiac Surgery With Cardiopulmonary Bypass: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Xiuxiu Xie ◽  
Siren Shi ◽  
Xinqi Cheng ◽  
Muya Lin ◽  
Lijian Chen
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Chest Tube ◽  
Control Group ◽  
Loading Dose ◽  
Risk Of Bleeding ◽  
Tube Output ◽  
Chest Tube Output

Abstract Background: Tranexamic acid (TXA) has been widely used to reduce the risk of bleeding in patients undergoing cardiac surgery. However, the clinical TXA dose that best reduces postoperative bleeding has not been determined. We evaluated the efficacy of two different doses of TXA using Thromboelastography (TEG) in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods: One hundred and eleven patients who underwent primary cardiac valve replacement with CPB were enrolled in this study. Patients were randomly divided into three groups: T1, T2, and the control group. Patients in the TXA group would receive different TXA doses: 15 mg/kg loading dose followed by an infusion of 5 mg/kg/h until the completion of surgery (T1 group) or 6 mg/kg loading dose followed by an infusion of 3 mg/kg/h until the completion of surgery (T2 group). Pre-operative patient characteristics, intraoperative data, transfusions between and after surgery, chest tube output after surgery within two days, and outcome data were recorded.Results: Transfusion of blood products, blood loss, and chest tube output were significantly reduced in the T1 group compared with the control group (P< 0.05). Compared to the control group, the T2 group had similar results. Surgical time and length of intensive care unit (ICU) stay were significantly lower in the T1 and T2 groups compared to the control group (P< 0.05). No postoperative seizures occurred in all three patient groups.Conclusions: The use ofTranexamic acid was associated with a lower risk of bleeding compared to the control group. Both doses of tranexamic acid were effective to reduce blood loss as well as transfusions compared to the control group.

Is Heparin the Ideal Anticoagulant for Cardiopulmonary Bypass? Dermatan Sulphate May Be an Alternate Choice

1994 ◽  
Vol 71 (04) ◽  
pp. 468-473 ◽  
Author(s):  
Stephanie J Brister ◽  
Frederick A Ofosu ◽  
George J F Heigenhauser ◽  
Francesco Gianese ◽  
Michael R Buchanan
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Side Effects ◽  
High Dose ◽  
Dermatan Sulphate ◽  
Protamine Sulphate ◽  
Adverse Side Effects ◽  
Dose Heparin ◽  
Alternate Choice ◽  
The Ideal

SummaryPerformance of cardiopulmonary bypass (CPB) during cardiac surgery requires the administration of high dose heparin to prevent CPB pump occlusion. However, this heparin use is associated with bleeding side-effects. Moreover, at the end of CPB, the heparin must be neutralized with protamine sulphate, which is also associated with adverse side-effects. A number of recent studies suggest that dermatan sulphate may be useful as an alternate anticoagulant to heparin. We determined whether CPB could be performed using dermatan sulphate instead of heparin, in an adult pig CPB model. When heparin was used, a high dose (> 200 U/kg, which generated > 3 anti-thrombin U/ml of plasma), was required to perform successful CPB and to maintain CPB pump patency. This dose was associated with a post CPB bleeding of ≈ 600 ml/2h. in contrast, successful CPB could be achieved when the pigs were given lower doses of dermatan sulphate than heparin, which in turn, were associated with less bleeding. We conclude that dermatan sulphate may be an alternate anticoagulant for cardiac surgery

Adverse side effects of dexamethasone in surgical patients

2015 ◽  
Author(s):  
Jorinde AW Polderman ◽  
Violet Farhang-Razi ◽  
Susan Van Dieren ◽  
Peter Kranke ◽  
J Hans DeVries ◽  
...  
Keyword(s):  
Side Effects ◽  
Surgical Patients ◽  
Adverse Side Effects
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