Drugs to minimize perioperative blood loss in cardiac surgery: Meta-analyses using perioperative blood transfusion as the outcome
Drugs to minimize perioperative blood loss in cardiac surgery: Meta-analyses using perioperative blood transfusion as the outcome
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DOI：
10.1097/00000539-199712000-00014
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发表时间：
1997-12-01
影响因子：
5.7
通讯作者：
Fergusson, D
中科院分区：
文献类型：
--
作者：
Laupacis, A;Fergusson, D
对同种异体红细胞输注副作用的关注增加了对尽量减少围手术期输血的方法的兴趣。我们对随机试验进行了荟萃分析，评估抑肽酶、去氨加压素、氨甲环酸和ε-氨基己酸在心脏手术中的有效性和安全性。所有确定的心脏手术随机试验均纳入荟萃分析。主要结局是接受至少一次围手术期同种异体红细胞输注的患者比例。60项研究被纳入荟萃分析。最大数量的患者（5808例）可用于抑肽酶的荟萃分析，抑肽酶显著降低了同种异体血液的暴露（比值比[OR] 0.31，95%置信区间[CI] 0.25-0.39; P < 0.0001）。无论手术类型（初次或再次手术）、阿司匹林使用或报告的输血阈值如何，抑肽酶的疗效均无显著差异。使用抑肽酶与因出血而需再次手术的显著减少相关（OR 0.44，95% CI 0.27-0.73; P = 0.001）。去氨加压素无效，OR为0.98（95%CI 0.64-1.50; P = 0.92）。氨甲环酸显著降低患者输血比例（OR 0.50，95%CI 0.34-0.76; P = 0.0009）。ε-氨基己酸对输血患者比例无统计学显著影响（OR 0.20，95% CI 0.04-1.12; P = 0.07）。没有足够的患者来排除任何药物引起的心肌梗死或其他副作用的小幅但具有临床意义的增加。我们的结论是，抑肽酶和氨甲环酸，而不是去氨加压素，减少患者暴露于围手术期同种异体输血与心脏手术。含义：抑肽酶、去氨加压素、氨甲环酸和ε-氨基己酸被用于心脏手术，试图减少需要输血的患者比例。所有已发表的随机试验的荟萃分析提供了这些药物疗效的良好估计，并有助于指导临床实践。我们的结论是，抑肽酶和氨甲环酸，而不是去氨加压素，减少患者暴露于异基因输血围手术期的关系，心脏手术。
Concern about the side effects of allogeneic red blood cell transfusion has increased interest in methods of minimizing perioperative transfusion. We performed meta-analyses of randomized trials evaluating the efficacy and safety of aprotinin, desmopressin, tranexamic acid, and epsilon-aminocaproic acid in cardiac surgery. All identified randomized trials in cardiac surgery were included in the meta-analyses. The primary outcome was the proportion of patients who received at least one perioperative allogeneic red cell transfusion. Sixty studies were included in the meta-analyses. The largest number of patients (5808) was available for the meta-analysis of aprotinin, which significantly decreased exposure to allogeneic blood (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.25-0.39; P < 0.0001). The efficacy of aprotinin was not significantly different regardless of the type of surgery (primary or reoperation), aspirin use, or reported transfusion threshold. The use of aprotinin was associated with a significant decrease in the need for reoperation because of bleeding (OR 0.44, 95% CI 0.27-0.73; P = 0.001). Desmopressin was not effective, with an OR of 0.98 (95% CI 0.64-1.50; P = 0.92). Tranexamic acid significantly decreased the proportion of patients transfused (OR 0.50, 95% CI 0.34-0.76; P = 0.0009). epsilon-Aminocaproic acid did not have a statistically significant effect on the proportion of patients transfused (OR 0.20, 95% CI 0.04-1.12; P = 0.07). There were not enough patients to exclude a small but clinically important increase in myocardial infarction or other side effects for any of the medications. We conclude that aprotinin and tranexamic acid, but not desmopressin, decrease the number of patients exposed to perioperative allogeneic transfusions in association with cardiac surgery. Implications: Aprotinin, desmopressin, tranexamic acid, and epsilon-aminocaprole acid are used in cardiac surgery in an attempt to decrease the proportion of patients requiring blood transfusion. This meta-analysis of all published randomized trials provides a good estimate of the efficacy of these medications and is useful in guiding clinical practice. We conclude that aprotinin and tranexamic acid, but not desmopressin, decrease the exposure of patients to allogeneic blood transfusion perioperatively in relationship to cardiac surgery.