Báo cáo y học: Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial

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: Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial...
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Báo cáo y học: "Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial" Available online http://ccforum.com/content/11/6/R117Research Open AccessVol 11 No 6Tranexamic acid attenuates inflammatory response incardiopulmonary bypass surgery through blockade of fibrinolysis:a case control study followed by a randomized double-blindcontrolled trialJuan J Jimenez1, Jose L Iribarren1, Leonardo Lorente1, Jose M Rodriguez2, Domingo Hernandez3,Ibrahim Nassar4, Rosalia Perez1, Maitane Brouard1, Antonio Milena5, Rafael Martinez4 andMaria L Mora11IntensiveCare Department, Hospital Universitario de Canarias, Ofra s/n La Cuesta, La Laguna, 38320, Spain2Hematology Department, Hospital Universitario de Canarias, Ofra s/n La Cuesta, La Laguna, 38320, Spain3Research Unit, Hospital Universitario de Canarias, Ofra s/n La Cuesta, La Laguna, 38320, Spain4Cardiac Surgery Department, Hospital Universitario de Canarias, Ofra s/n La Cuesta, La Laguna, 38320, Spain5Biochemistry and Central Laboratories, Hospital Universitario de Canarias, Ofra s/n La Cuesta, La Laguna, 38320, SpainCorresponding author: Juan J Jimenez, jjjimenezrivera@gmail.comReceived: 17 Jul 2006 Revisions received: 25 May 2007 Accepted: 7 Nov 2007 Published: 7 Nov 2007Critical Care 2007, 11:R117 (doi:10.1186/cc6173)This article is online at: http://ccforum.com/content/11/6/R117© 2007 Jimenez et al.; licensee BioMed Central Ltd.This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractIntroduction Extracorporeal circulation induces hemostatic independent protective variable (odds ratio 0.38, 95%alterations that lead to inflammatory response (IR) and confidence interval 0.18 to 0.81; P < 0.01). The clinical trial waspostoperative bleeding. Tranexamic acid (TA) reduces interrupted. Fifty patients were randomly assigned to receive TAfibrinolysis and blood loss after cardiopulmonary bypass (CPB). (24) or placebo (26). Incidence of IR was 17% in the TA groupHowever, its effects on IR and vasoplegic shock (VS) are not versus 42% in the placebo group (P = 0.047). In the TA group,well known and elucidating these effects was the main objective we observed a significant reduction in the incidence of VS (P =of this study. 0.003), the use of norepinephrine (P = 0.029), and time on mechanical ventilation (P = 0.018). These patients showedMethods A case control study was carried out to determine significantly lower D-dimer, plasminogen activator inhibitor 1,factors associated with IR after CPB. Patients undergoing and creatine-kinase levels and a trend toward lower levels ofelective CPB surgery were randomly assigned to receive 2 g of soluble tumor necrosis factor receptor and interleukin-6 withinTA or placebo (0.9% saline) before and after intervention. We the first 24 hours after CPB.performed an intention-to-treat analysis, comparing theincidence of IR and VS. We also analyzed several biologicalparameters related to inflammation, coagulation, and fibrinolysis Conclusion The use of TA attenuates the development of IR andsystems. We used SPSS version 12.2 for statistical purposes. VS after CPB.Results In the case control study, 165 patients were studied,20.6% fulfilled IR criteria, and the use of TA proved to be an Trial registration number ISRCTN05718824. and coagulation-fibrinolytic cascades, among others. The coagulation-fibrinolytic cascades and the IR, though in manyIntroduction respects separate processes, are closely interconnected [1].Cardiopulmonary bypass (CPB) may activate an inflammatory Several preoperative and perioperative risk factors for IR haveresponse (IR) involving contact system, complement, cytokine,CI = confidence interval; CPB = cardiopulmonary bypass; ICU = intensive care unit; IL-6 = interleukin-6; IR = inflammatory response; OR = oddsratio; PAI-1 = plasminogen activator inhibitor 1; PT = prothrombin time; STNFR = soluble tumor necrosis factor receptor; TA = tranexamic acid; VS= vasoplegic shock. Page 1 of 10 (page number not for citation purposes)Critical Care Vol 11 No 6 Jimenez et al.been proposed [2,3]. The incidence of vasoplegic shock (VS), similar in the two studies (Materials and methods, part 2),the most severe presentation of IR, may be as high as 10% [4]. except for the study medication. In this study, the surgeon decided when to use TA.Numerous strategies to reduce IR and bleeding in high-riskpatients exist, among which is the use of aprotinin [5]. Like ...