Báo cáo y học: Increased bleeding risk associated with the use of recombinant human activated protein C in patients with advanced liver diseas

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Increased bleeding risk associated with the use of recombinant human activated protein C in patients with advanced liver disease...
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Báo cáo y học: "Increased bleeding risk associated with the use of recombinant human activated protein C in patients with advanced liver diseas" Available online http://ccforum.com/content/12/1/405LetterIncreased bleeding risk associated with the use of recombinanthuman activated protein C in patients with advanced liver diseaseAdam Keene1, Thomas Kawano2, Syed Anees3 and Julie Chen41Division of Critical Care Medicine, Montefiore Medical Center, Bronx, New York, USA2Department of Internal Medicine, Montefiore Medical Center, Bronx, New York, USA3Division of Pulmonary Medicine, Montefiore Medical Center, Bronx, New York, USA4Division of Pharmacy, Montefiore Medical Center, Bronx, New York, USACorresponding author: Adam Keene, akeene@montefiore.orgPublished: 11 February 2008 Critical Care 2008, 12:405 (doi:10.1186/cc6774)This article is online at http://ccforum.com/content/12/1/405© 2008 BioMed Central LtdAdvanced liver disease (ALD) was an exclusion criteria from we decided to evaluate whether such patients have anenrollment in the major clinical trials of recombinant human increased risk for bleeding during APC administration.activated protein C (APC), but is listed on the package insertas a relative contraindication rather than an absolute contra- We retrospectively reviewed a database of all adult patientsindication to APC administration [1]. There are recent reports who have received APC at Montefiore Medical Center sinceof elevated rates of bleeding due to APC in clinical practice, the drug’s approval. All patients at Montefiore Medical Centerparticularly in patients with relative contraindications to the with severe sepsis at high risk for death and without absolutedrug [2,3]. Since many patients who develop septic shock at contraindications are considered eligible for APC at theMontefiore Medical Center in the Bronx, New York have ALD, discretion of the attending intensivist. Overall, 41 patientsTable 1Patient characteristics and outcomesVariable ALD present (n = 10) ALD absent (n = 24) P valueAPACHE II (mean (standard deviation)) 29.3 (6.3) 27.8 (5.1) 0.46Age (years) (mean (standard deviation)) 50.2 (6.7) 57.4 (14.8) 0.15Male gender (n (%)) 6 (60.0) 13 (54.2) 0.75Hispanic race (n (%)) 4 (40.0) 9 (37.5) 0.89Black race (n (%)) 4 (40.0) 9 (37.5) 0.89White race (n (%)) 2 (20.0) 6 (35.0) 0.75Major surgery (n (%)) 2 (20.0) 10 (41.6) 0.23Pulmonary source (n (%)) 7 (70.0) 9 (37.5) 0.08Gastrointestinal source (n (%)) 1 (10.0) 8 (33.3) 0.16Bloodstream source (n (%)) 2 (20.0) 3 (12.5) 0.57Skin source (n (%)) 0 (0.0) 3 (12.5) 0.24Genitourinary source (n (%)) 0 (0.0) 1 (4.2) 0.51Major bleeding episode (n (%)) 5 (50.0) 4 (16.7) 0.0428-day mortality 6 (60.0) 5 (20.8) 0.03ALD, advanced liver disease as defined by the presence of chronic jaundice or ascites, cirrhosis, or portosystemic hypertension; APACHE, AcutePhysiology and Chronic Health Evaluation. P values determined by chi-squared test or Fisher’s exact test of proportions.ALD = advanced liver disease; APC = activated protein C. Page 1 of 2 ...