Postoperative Costs Associated With Outcomes After Cardiac Surgery With Extracorporeal Circulation: Role of Antithrombin Levels

Muedra, Vicente; Llau, Juan V.; Llagunes, J.; Paniagua, Pilar; Veiras, S.; Fernández-López, A.; Diago, Carlos Amado; Hidalgo, F.; Gil, José; Valiño, Cristina; Moret, E.; Gómez, Lourdes; Pajares, A.; Prada, Blanca de

doi:10.1053/j.jvca.2012.08.017

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…These complications are the main causes of morbidity and mortality after a cardiac surgery [10], contributing for the increase of length of hospital stay and its cost [11,12]. works with specific functions wished to be recovered, mainly in attention, memory, physical strength and using challenging strategies [22].…”

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confidence: 99%

The use of the virtual reality as intervention tool in the postoperative of cardiac surgery

Cacau¹,

Oliveira²,

Maynard³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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Veja reportagem sobre o tema desenvolvido neste artigo acessando o link: http://globotv.globo.com/tv-sergipe/se-tv-2a-edicao/v/games-sao-terapiapara-pacientes-cardiacos-em-aracaju/2194856/ EXPERIMENTAL STUDY Abstract Introduction: Cardiac surgery has been the intervention of choice in many cases of cardiovascular diseases. Susceptibility to postoperative complications, cardiac rehabilitation is indicated. Therapeutic resources, such as virtual reality has been helping the rehabilitational process. The aim of the study was to evaluate the use of virtual reality in the functional rehabilitation of patients in the postoperative period.Methods: Patients were randomized into two groups, Virtual Reality (VRG, n = 30) and Control (CG, n = 30). The response to treatment was assessed through the functional independence measure (FIM), by the 6-minute walk test (6MWT) and the Nottingham Health Profile (NHP). Evaluations were performed preoperatively and postoperatively.Results: On the first day after surgery, patients in both groups showed decreased functional performance. However, the VRG showed lower reduction (45.7±2.3) when compared to CG (35.06±2.09, P<0.05) in first postoperative day, and no significant difference in performance on discharge day (P>0.05). In evaluating the NHP field, we observed a significant decrease in pain score at third assessment (P<0.05). These patients also had a higher energy level in the first evaluation (P<0.05). There were no differences with statistical significance for emotional reactions, physical ability, and social interaction. The length of stay was significantly shorter in patients of VRG (9.4±0.5 days vs. 12.2 ± 0.9 days, P<0.05), which also had a higher 6MWD 282Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Bras Cir Cardiovasc 2013;28(2):281-9 Rev

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confidence: 99%

The use of the virtual reality as intervention tool in the postoperative of cardiac surgery

Cacau¹,

Oliveira²,

Maynard³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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“…A multicenter Spanish study found that patients with low postoperative AT levels (< 63.7% activity) had higher total hospital costs, which were related mainly to the need for perioperative transfusions and increased hospital length of stay. 35 In another cost-based study, the question of whether to correct AT activity when levels are low, but therapeutic coagulation achieved, was addressed retrospectively both in ECMO and CPB patients. 19 These authors found that using activity alone as an indicator resulted in significantly wasted resources and excessive costs that could be mitigated by using higher weight-based dosing and rounding to the nearest vial size.…”

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confidence: 99%

Application of goal-directed therapy for the use of concentrated antithrombin for heparin resistance during cardiac surgery

Stammers¹,

Francis²,

Miller³

et al. 2020

Perfusion

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The maintenance of anticoagulation in adult patients undergoing cardiopulmonary bypass is dependent upon a number of factors, including heparin concentration and adequate antithrombin activity. Inadequate anticoagulation increases the risk of thrombosis and jeopardizes both vascular and extracorporeal circuit integrity. The purpose of this study was to evaluate a goal-directed approach for the use of antithrombin in patients who were resistant to heparin. Following institutional review board approval, data were obtained from quality improvement records. A goal-directed protocol for antithrombin was established based upon heparin dosing (400 IU kg−1 body weight) and achieving an activated clotting time of ⩾500 seconds prior to cardiopulmonary bypass. Two groups of patients were identified as those receiving antithrombin and those not receiving antithrombin. Outcome measures included activated clotting time values and transfusion rates. Consecutive patients (n = 140) were included in the study with 10 (7.1%) in the antithrombin group. The average antithrombin dose was 1,029.0 ± 164.5 IU and all patients had restoration to the activated clotting time levels. Patients in the antithrombin group were on preoperative heparin therapy (80.0% vs. 24.6%, p = 0.001). Prior to cardiopulmonary bypass the activated clotting time values were lower in the antithrombin group (417.7 ± 56.1 seconds vs. 581.1 ± 169.8 seconds, p = 0.003). Antithrombin patients had a lower heparin sensitivity index (0.55 ± 0.17 vs. 1.05 ± 0.44 seconds heparin−1 IU kg−1, p = 0.001), received more total heparin (961.3 ± 158.5 IU kg−1 vs. 677.5 ± 199.0 IU kg−1, p = 0.001), more cardiopulmonary bypass heparin (22,500 ± 10,300 IU vs. 12,100 ± 13,200 IU, p = 0.016), and more protamine (5.4 ± 1.2 vs. 4.1 ± 1.1 mg kg−1, p = 0.003). The intraoperative transfusion rate was higher in the antithrombin group (70.0% vs. 35.4%, p = 0.035), but no differences were seen postoperatively. Utilization of a goal-directed algorithm for the administration of antithrombin for the treatment of heparin resistance is effective in patients undergoing cardiac surgery.

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“…Severe deficiency of AT, hence increasing the risk of thrombotic event has been associated with antineoplastic agent such as a L -asparaginase, estrogen-containing contraceptives ( Hernández-Espinosa et al, 2009 ) or genetic defects on exons or flanking regions of SERPINC1 ( Toderici et al, 2016 ), increase the risk of thrombotic events. AT deficiency in the early postoperative period following major surgery ( Duswald et al, 1985 ; Jordan et al, 1987 ; Matsutani et al, 1998 ) has also been associated with increased morbidity and mortality ( Fourrier et al, 1992 ; Hasegawa et al, 1994 ; Ranucci et al, 1999 , 2005 ; Paparella et al, 2009 ; Muedra et al, 2013a , b ).…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone Preconditioning in Cardiac Procedures Reduces Decreased Antithrombin Activity and Is Associated to Beneficial Outcomes: Role of Endothelium

et al. 2018

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Introduction: Decreased antithrombin (AT) activity in patients scheduled for cardiovascular surgery under cardiopulmonary bypass (CPB) is related to increased postoperative complications and hospitalization time. Indirect evidence suggests that glucocorticoids mitigate this decreased AT activity. To better understand the beneficial effects of AT we have analyzed: (i) the clinical relevance of acute dexamethasone (DX) administration before cardiac surgery on AT activity, (ii) the modulation by DX of AT expression in human endothelial cells (hECs), (iii) the activity of AT on migration and angiogenesis of hECs, or on angiogenesis of rat aorta.Methods: A retrospective cohort study in patients undergoing aortic valve replacement surgery was designed to evaluate the effect of DX administration on AT activity at five separate time points: preoperatively, during CPB, at intensive care unit admission and at 12 and 24 h post-intervention. We have analyzed also clinical differences in postoperative outcomes as safety and the length of stay in hospitalization. Changes in mRNA levels of AT induced by DX were determined by qRT-PCR in human coronary (hCEC), aorta (hAEC) and cardiac microvasculature (hCMEC) endothelial cells. AT activity on migration and angiogenesis were also assayed. Angiogenic growth of rat aortic rings incubated in Matrigel® was determined in presence and absence of AT.Results: The cohort comprised 51 patients in the control group and 29 patients in the group receiving dexamethasone. Preoperative DX supplementation reduced intraoperative decrease of AT activity (67.71 ± 10.49% DX treated vs. 58.12 ± 9.11% untreated, p < 0.001) that could be related to a decrease in the hospitalization time (7.59 ± 4.08 days DX treated vs. 13.59 ± 16.00 days untreated, p = 0.014). Treatment of hECs with 500 nM DX slightly increased AT expression. Incubation with 0.5 and 1 IU/mL of AT increased migration and angiogenesis in hCAECs and hAECs, but not in hCMECs. The same concentrations of AT potentiated angiogenic sprouting of new vessels from rat aorta.Conclusion: Preoperative DX supplementation could be an interesting procedure to avoid excessive decrease in AT levels during cardiac surgery. Positive outcomes associated with maintaining adequate AT levels could be related to its potential beneficial effect on endothelial function (migration and angiogenesis).

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Postoperative Costs Associated With Outcomes After Cardiac Surgery With Extracorporeal Circulation: Role of Antithrombin Levels

Cited by 5 publications

References 31 publications

The use of the virtual reality as intervention tool in the postoperative of cardiac surgery

The use of the virtual reality as intervention tool in the postoperative of cardiac surgery

Application of goal-directed therapy for the use of concentrated antithrombin for heparin resistance during cardiac surgery

Dexamethasone Preconditioning in Cardiac Procedures Reduces Decreased Antithrombin Activity and Is Associated to Beneficial Outcomes: Role of Endothelium

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