Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

Santos, Ari-Tadeu Lírio dos; Splettstosser, João Carlos; Warpechowski, Paulo; Gaidzinski, Mariana Mariz Pinto

doi:10.1590/s0034-70942007000500011

Cited by 4 publications

(7 citation statements)

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“…Atualmente são três os agentes antifibrinolíticos mais empregados: um inibidor de protéases séricas de amplo espectro, a aprotinina, e dois análogos do aminoácido lisina, o AEAC (ácido aminocapróico) e o AT (ácido tranexâmico), que inibem a fibrinólise. A diminuição do sangramento com esses fármacos varia, na maioria dos estudos, entre 30% a 50% (SANTOS et al, 2007).…”

Section: Discussionunclassified

Agentes Antifibrinolíticos Na Prática Anestésica Atual: Quais as Evidências Para Seu Uso

Regiani¹,

Silva²

2018

Rev. Uningá

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Avaliar o papel dos agentes antifibrinolíticos como parte de uma estratégia moderna de prevenção de sangramento em pacientes com risco de hemorragia perioperatória e pós operatória em cirurgia cardíaca ou não cardíaca, trauma ou parto. Resume a literatura da última década com relevância para a prática anestésica e cirúrgica diária, para apoiar a tomada de decisões clínicas e para aprimorar o conhecimento sobre o tema. Trata-se de um levantamento bibliográfico de artigos científicos atuais, relacionados ao tema nas seguintes bases de dados: Medline, Lilacs e Scielo. As pesquisas mostram uma redução de sangramento intraoperatório que se estende ao período pós operatório. Verificou-se a redução no número de transfusão de concentrado de hemácias, perda sanguínea intraoperatória e consequente redução de morbidade e mortalidade referentes às complicações cirúrgicas e transfusionais.

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Section: Discussionunclassified

Agentes Antifibrinolíticos Na Prática Anestésica Atual: Quais as Evidências Para Seu Uso

Regiani¹,

Silva²

2018

Rev. Uningá

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“…Intravenous administration in a single dose or repeated doses was used initially in orthopaedic procedures, based on previous studies in cardiac surgery [ 17 ]. However, there is evidence demonstrating that only a fraction of the injected drug reaches the target tissue, which in turn reduces its effectiveness [ 10 ]; that up to 95% of the drug can be eliminated in the urine; and that in patients with impaired kidney function, the dosage needs to be corrected [ 19 ]. When administered in high doses or injected quickly, minor gastrointestinal symptoms, such as nausea and vomiting, have been reported [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, tranexamic acid (TXA) has been used as an adjuvant to such measures [ 6 - 18 ]. TXA is an analogue of lysine and inhibits fibrinolysis and blocks, with high affinity, the lysine to plasminogen binding sites, thereby preventing formation of the complex between plasminogen, fibrin and tissue plasminogen activator [ 19 ] (Fig. 1 ).…”

Section: Introductionmentioning

confidence: 99%

Application of Tranexamic Acid in Total Knee Arthroplasty – Prospective Randomized Trial

Guerreiro¹,

Badaro²,

Balbino³

et al. 2017

TOORTHJ

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Background:The use of tranexamic acid (TXA) in total knee arthroplasty (TKA) has shown good results. Bleeding may cause local complications consequently greater pain and reduced function postoperatively. No study has related the use of TXA to these facts.Objective:The aim was to evaluate the effects of TXA haemoglobin, Western Ontario and McMaster Universities Index (WOMAC), pain intensity and flexion gain after TKA.Methods:43 patients were randomized and then underwent TKA. TXA was applied to 22 of these patients before closure of the joint capsule. Haemoglobin measurements (mg/dL) were taken preoperatively and 24 and 48 hours after surgery. The WOMAC questionnaire and pain visual analogue scale (VAS) were applied, and flexion gain was measured up to the second postoperative month. Statistical analysis compared the results to determine whether there were differences between the groups for each of the evaluated times.Results:There were differences in favour of the drug 48 hours postoperatively for the haemoglobin variable (p = 0.01), in pain evaluation, 24 and 48 hours, postoperatively (p < 0.01) and in flexion gain, 24 hours after surgery (p = 0.03). There were no significant differences between the groups in the haemoglobin evaluation 24 hours postoperatively, in pain assessment 7 days, 21 days and 2 months, postoperatively, in flexion gain 48 hours, 7 days, 21 days and 2 months, postoperatively and in WOMAC after 2 months.Conclusion:In addition to reducing bleeding, topical TXA improved pain and increased flexion gain in the first hours after TKA.Trial Registration:RBR-9b4qgq

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“…However, the patient who undergoes cardiac surgery, especially with CPB, may experience massive blood losses due to non-surgical causes, surgical causes or coagulation disorders. If not controlled, massive bleeding can contribute to increased patient morbidity and mortality (Miana et al, 2004;Whitlock et al, 2005;Santos et al, 2007;Costa et al, 2012;Wikkelsø et al, 2016;Lodewyks et al, 2018). The control of massive bleeding is achieved through the transfusion of blood, blood products, and blood components.…”

Section: Introductionmentioning

confidence: 99%

Rotational thromboelastometry in the perioperative period of cardiac surgeries: cost-effectiveness analysis and budget impact

Santos¹,

Oliveira²,

Fernandes³

et al. 2020

JBES

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Objective: The transfusion of blood components and blood products in cardiac surgery patients can be guided by protocols based on standard laboratory tests and/or clinical decisions (Standardof-Care, SOC) or viscoelastic haemostatic assays (VHA). The aim of this study is to evaluate the cost-effectiveness and budget impact of VHAs compared to SOC. Methods: A decision tree model was built in TreeAge Pro® 2009. Costs and benefits were taken from the medical literature. The costeffectiveness was evaluated in a base-case scenario and a worst-case scenario, considering low costs of adverse events. The budget impact was evaluated from data taken from Datasus. Cost data were measured in 2019 USD and outcomes were measured in QALYs. Results: VHAs were considered dominant in the base-case scenario and very cost-effective in the worst-case scenario (ICER = $1,083.21 USD/QALY). The budget impact analysis varied from a cost-saving result in the base-case scenario to a reasonable increase in cost in the worst-case scenario. Since the total market share of the technology is unlikely, a reasonable estimative for the base-case scenario and the worst-case scenario are about -$275 million USD and $132 million USD, respectively. Conclusion: We conclude that the VHAs are cost-effective and should be recommended for the use in the perioperative period of cardiac surgeries, especially for patients with a high risk of hemorrhage or coagulation problems.

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Antifibrinolíticos e cirurgia cardíaca com circulação extracorpórea

Cited by 4 publications

References 50 publications

Agentes Antifibrinolíticos Na Prática Anestésica Atual: Quais as Evidências Para Seu Uso

Agentes Antifibrinolíticos Na Prática Anestésica Atual: Quais as Evidências Para Seu Uso

Application of Tranexamic Acid in Total Knee Arthroplasty – Prospective Randomized Trial

Rotational thromboelastometry in the perioperative period of cardiac surgeries: cost-effectiveness analysis and budget impact

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