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The Annals of Thoracic Surgery, Vol 58, 1580-1588, Copyright © 1994 by The Society of Thoracic Surgeons
SE Fremes, BI Wong, E Lee, R Mai, GT Christakis, RF McLean, BS Goldman and CD Naylor
Prophylactic drug treatment is one of several strategies to reduce
postoperative blood loss and potentially limit homologous blood use in open
heart surgery. A computerized MEDLINE search supplemented with manual
bibliography reviews was performed for randomized clinical trials published
in peer-reviewed English-language journals from January 1980 to June 1993.
A metaanalysis was conducted of trials evaluating desmopressin (group DD, n
= 13), epsilon-aminocaproic acid or tranexamic acid (group EA, n = 4), and
aprotinin (group AP, n = 16). Eligible studies used placebo controls and
administered the drug in a prophylactic manner. The primary study end point
was postoperative chest tube loss (mL, mean +/- standard deviation). There
was a significant reduction in postoperative chest tube loss detected for
each of the active treatments versus the placebo (DD versus controls:
percent reduction 0.11, p = 0.0021; EA versus controls: percent reduction
0.30, p < 0.0001; and AP versus controls: percent reduction 0.36, p <
0.0001). Therapy with EA or AP was associated with a greater reduction in
chest tube loss than DD (EA versus DD, p = 0.0033, and AP versus DD, p <
0.0001). Secondary study end points were transfusion requirements, chest
reexploration, and perioperative mortality. The volume of postoperative red
cell transfusion (mean +/- standard deviation) was reduced with EA (p <
0.0001) or AP treatment (p < 0.0001) compared with a placebo or DD,
whereas the proportion of patients given transfusions was limited only in
the AP-treated patients (odds ratio 0.23; 95% confidence interval, 0.16 to
0.33; p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding
Department of Anaesthesia, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
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