RESUMO
BACKGROUND: Microvascular bleeding after Cardiopulmonary bypass (CPB) is mainly due to consumption of clotting factors, platelets damage, and hyperfibrinolysis. Aprotinin, the only antifibrinolytic drug effective in preserving platelets, is no longer available; an alternative regimen based on pure antifibrinolytic drugs has been proposed, since hyperfibrinolysis is known to contribute both to clot lysis and platelet dysfunction. In this study the efficacy of two antifibrinolytic drugs, Tranexamic acid (TA) and epsilon-aminocaproic acid (EACA), was tested in patients undergoing cardiopulmonary bypass (CPB), for primary myocardial revascularization. METHODS: Forty-eight consecutive patients were randomized to receive prophylactically equipotent doses of EACA (group A) or TA (Group B). Platelet count, prothrombin time, fibrin digestion products, blood loss and transfusion requirements recorded after 6 and 24 hours from the end of surgery were compared. RESULTS: The two groups were comparable for length of CPB and numbers of grafts; no significant difference was observed in the coagulation parameters considered. Blood losses were less in group B (TA) than in group A (EACA), both at 6 and 24 hours after surgery; homologous blood transfused was also less in group B, but no difference was statistically significant. No adverse effect was observed. CONCLUSIONS: In coronary patients, TA and EACA exhibit the same effects on blood loss and requirements after CPB; either drug can be safely used in cardiac surgery.
Assuntos
Ácido Aminocaproico/uso terapêutico , Antifibrinolíticos/uso terapêutico , Ponte Cardiopulmonar , Hemorragia Pós-Operatória/tratamento farmacológico , Ácido Tranexâmico/uso terapêutico , Humanos , Pessoa de Meia-IdadeAssuntos
Catarata/complicações , Glaucoma/complicações , Facoemulsificação/métodos , Trabeculectomia/métodos , Câmara Anterior/cirurgia , Túnica Conjuntiva/cirurgia , Seguimentos , Glaucoma/cirurgia , Humanos , Iris/diagnóstico por imagem , Complicações Pós-Operatórias , Estudos Prospectivos , Refração Ocular , Esclera/cirurgia , Retalhos Cirúrgicos , Técnicas de Sutura , Resultado do Tratamento , Ultrassonografia , Acuidade VisualRESUMO
We describe our most recent findings about the use of epinephrine for cardiac arrest particularly referring to the mechanism of action, doses, modalities of administration and action on the cerebral circulation. Epinephrine is the elective drug in cardiocerebral resuscitation; but its use does not modify the final results which are still unsatisfying. The percentage of patients surviving cardiac arrest is very low, and many of them suffer important neurological damage.
