American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
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Am J Health Syst Pharm · Sep 2005
ReviewOverview of clinical efficacy and safety of pharmacologic strategies for blood conservation.
The pharmacologic management of hemostasis in patients undergoing surgery with cardiopulmonary bypass is discussed. ⋯ The future of cardiac surgery will be marked by an increasingly complex, high-risk group of patients and a greater need for multiple pharmacologic options for reducing bleeding. Pharmacologic approaches that attenuate the activation of the hemostatic system and inflammation need to be employed to decrease coagulopathies and the need for allogeneic blood administration.
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Am J Health Syst Pharm · Sep 2005
Review Meta AnalysisImproving clinical outcomes in coronary artery bypass graft surgery.
Medical decisions are often made based on personal experience or on limited clinical trial information. Results from systematic reviews of clinical trials, however, provide a more thorough understanding of available data and can foster evidence-based decision making. Data from a recent systematic review and meta-analysis of clinical outcomes after aprotinin treatment during coronary artery bypass graft (CABG) surgery have recently been published. This analysis was performed to further address concerns that aprotinin safety often outweighs the well-established transfusion reduction benefits. ⋯ Results from this systematic review and meta-analysis of randomized controlled trials in CABG surgery patients have shown that aprotinin was associated with a reduction in the need for blood transfusion, but was not associated with an increase in mortality, myocardial infarction, or renal failure risk. Evidence also suggests that aprotinin was associated with a reduced stroke risk and a trend toward a reduced incidence of atrial fibrillation.
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The pharmacotherapy and assessment of postoperative pain in general pharmacy practice settings are reviewed. ⋯ Providing optimal management of postoperative pain is a vital goal for all health care providers. There is substantial potential for pharmacists to help meet this goal.
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Am J Health Syst Pharm · Sep 2005
ReviewReview and application of serine protease inhibition in coronary artery bypass graft surgery.
Current pharmacologic agents, aprotinin, epsilon aminocaproic acid, and tranexamic acid, used to decrease blood loss and transfusion requirements during coronary artery bypass graft (CABG) surgery are discussed. Aprotinin is the only agent that also modulates the systemic inflammatory responses that are generated by contact activation during CABG surgery. These responses are largely mediated by serine proteases such as kallikrein, thrombin, and plasmin. ⋯ Aprotinin is the only agent that has an FDA indication to prevent blood loss and transfusion during CABG surgery, and the additional benefit of attenuating the systemic inflammatory response associated with CABG with CPB.