The Journal of extra-corporeal technology
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J Extra Corpor Technol · Dec 2007
ReviewAntifibrinolytic therapy: evidence, bias, confounding (and politics!).
Cardiac surgery can be complicated by postoperative bleeding and a need for blood transfusion and surgical reexploration. Anti-fibrinolytic drugs such as aprotinin and tranexamic acid may reduce bleeding risks but could possibly increase thrombotic complications. Aprotinin, in particular, has recently been implicated in at least two large observational studies, but this could be because it is more widely used in high-risk cardiac surgical patients. ⋯ Although multivariate adjustment and propensity score-matching can adjust for confounding, there is no certainty that it removes all such bias. For all anti-fibrinolytic drugs, it remains unclear as to whether the beneficial effect on reduced bleeding outweighs a possible increased risk of thrombotic complications. Debate will continue until we have the results of definitive large randomized trials powered to detect a clinically important effect on outcome.
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J Extra Corpor Technol · Dec 2007
In vitro drug adsorption and plasma free hemoglobin levels associated with hollow fiber oxygenators in the extracorporeal life support (ECLS) circuit.
The purpose of this study was to identify the percentage of fentanyl or morphine sulfate lost from adhesion to either the polyvinylchloride (PVC) tubing or the surface of two different hollow fiber oxygenators used in current extracorporeal life support circuits and to identify any difference in the plasma free hemoglobin (PFH) levels generated when using these oxygenator and/or drug combinations. For each drug examined, six simple circuits were assembled; for each drug, two circuits contained tubing without an oxygenator (control), two circuits contained the Jostra Quadrox D (Maquet Cardiopulmonary, AG Hirrlingen, Germany), and two circuits contained the Terumo Baby Rx (Terumo Cardiovascular Systems Corp., Ann Arbor, MI). Fentanyl or morphine sulfate was added to yield initial circuit concentrations equal to 1430 ng/mL, respectively. ⋯ During this in vitro study, the majority of both drugs were lost to the PVC tubing. The type of oxygenator did not seem to significantly affect PFH. However, fentanyl in any combination or alone was associated with increased PFH levels.