АКШ
.pdfData Supplement 39. Renal Dysfunction
Study Name |
Aim of Study |
Study Type |
Study |
Patient Population/Inclusion & |
Endpoints |
Statistical |
P-Values & 95% |
OR / HR / RR |
Study Summary |
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Size |
Exclusion Criteria |
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Analysis |
CI |
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Reported |
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Inclusion Criteria |
Exclusion |
Primary |
Secondary |
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Criteria |
Endpoint |
Endpoint |
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Renal failure |
Identify the |
Retrospective |
649 |
All cardiac surgery |
N/A |
ARF, ARF- |
N/A |
Multivariate |
Cardiac |
Cardiac |
Cardiac catheterization within 5 |
after cardiac |
relationship |
single center |
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patients on |
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D, hospital |
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catheterization |
catheterization |
d of cardiac operation, baseline |
surgery: |
between |
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dialysis, cardiac |
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mortality |
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within 5 d; |
within 5 d OR: |
preoperative renal dysfunction, |
timing of |
timing of |
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transplant, VAD, |
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p=0.010; 95% CI: |
1.82; baseline |
prolonged CPB time are |
cardiac |
preoperative |
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emergency, aortic |
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1.17 to 2.84; |
GFR <60 mL/min |
significant risk factors for ARF. |
catheterizatio |
cardiac |
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dissection. |
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baseline GFR |
1.69. |
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n and other |
catheterization |
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<60 mL/min; |
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perioperative |
and incidence |
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p=0.047; 95% CI: |
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risk factors. |
of |
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1.09 to 2.62 |
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2007 (272) |
postoperative |
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ARF |
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The effect of |
To assess the |
Single center |
395 |
CABG on-pump |
Patients on |
ARF |
Perioperative |
Multivariate |
1 d interval |
<1 d interval OR: |
CABG should be delayed in the |
cardiac |
effect of |
retrospective |
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dialysis and |
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mortality, |
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p=0.07; 95% CI: |
3.7; eClCr <60 |
presence of high contrast dose |
angiography |
timing of |
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salvage |
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ICU and |
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1.4 to 8.3; ClCr |
mL/min; OR: 7.1 |
and preoperative renal |
timing, |
cardiac |
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operations, |
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hospital stay |
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<60 mL/min; |
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dysfunction for at least 5 d after |
contrast |
angiography |
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referred from |
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95% CI: 3 to 16; |
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cardiac catheter |
media dose, |
and prevalence |
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OSH. |
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p<0.001 |
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and |
of ARF after |
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preoperative |
cardiac |
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renal function |
surgery |
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on ARF after |
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CABG. 2010 |
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(273) |
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Influence of |
Identify the |
Single center |
423 |
Elective on-pump |
Preop dialysis, |
ARF |
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Multivariate |
Same day cardiac |
Same day cardiac |
Cardiac surgery and |
the Timing of |
influence of |
retrospective |
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cardiac surgery |
emergent/urge |
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catheterization/su |
catheterization |
catheterization same d increased |
Cardiac |
timing of |
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nt surgery/off- |
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rgery p=0.039; |
/surgery; OR: |
risk 3-fold for ARF |
Catheterizatio |
cardiac |
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pump |
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95% CI: 1.06 to |
3.05 |
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n and the |
catheter and |
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8.78 |
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Amount of |
ARF after |
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Contrast |
cardiac |
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Media on |
surgery |
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Acute Renal |
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Failure After |
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© American College of Cardiology Foundation and American Heart Association, Inc.
Cardiac Surgery. 2008 (274)
ARF, acute renal failure; ARF-D, acute renal failure-dialysis; CABG, coronary artery bypass graft; CI, confidence interval; CPB, cardiopulmonary bypass; d, day; eCrCl, estimated creatinine clearance; GFR, glomerular filtration rate; HR, hazard ratio; ICU, intensive care unit; N/A, not applicable; OR, odds ratio; RR, relative risk; and VAD, ventricular assist device.
Data Supplement 40. Perioperative Bleeding/Transfusion
Study Name |
Aim of Study |
Study Type |
Study |
Patient Population/Inclusion & |
Endpoints |
Statistical Analysis |
P |
OR / |
Study Summary |
Study Limitations |
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Size |
Exclusion Criteria |
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Reported |
Values |
HR / |
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& 95% |
RR |
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CI |
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Inclusion |
Exclusion |
Primary |
Secondary |
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Criteria |
Criteria |
Endpoint |
Endpoint |
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Preoperative |
To investigate |
Retrospectiv |
111 |
CABG patients |
Not CABG |
Bleeding |
N/A |
Greater percentage |
p=0.001 |
N/A |
Increased blood loss |
Median time interval for |
Use of |
if the use of |
e |
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patients |
events |
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of patients on |
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and reoperative for |
discontinued LMWH was |
Enoxaparin |
LMWH or |
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LMWH required |
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bleeding in the |
21 h. |
increases the |
PLT inhibitors |
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mediastinal re- |
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LMWH group. |
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Risk of |
increased the |
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exploration for |
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Postoperative |
risk of |
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nonsurgical |
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Bleeding and |
bleeding in |
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bleeding versus |
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reexploration |
CABG. |
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control (17% vs. |
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in cardiac |
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0% , respectively). |
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surgery |
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patients. 2005 |
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(275) |
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© American College of Cardiology Foundation and American Heart Association, Inc.
Preoperative |
To investigate |
Retrospectiv |
1159 |
Patients |
1) The patient |
Bleeding |
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Re-exploration was |
p=0.03 |
HR: |
Enoxaparin |
N/A |
use of |
if the use of |
e |
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presented with a |
received no |
events |
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7.9% in the |
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2.6 |
administration within |
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enoxaparin |
LMWH |
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diagnosis of UA |
antithrombotic |
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enoxaparin group |
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48 h of surgery |
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compared |
compared with |
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or non Q–wave |
therapy (UFH or |
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and 3.7% in the |
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increases the risk of |
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with UFH |
UFH increased |
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MI and (2) the |
enoxaparin) within |
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UFH group. |
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reoperative bleeding. |
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increases the |
the risk of |
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patient received |
48 h of the |
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incidence of |
bleeding in |
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antithrombotic |
surgical procedure |
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re-exploration |
cardiac |
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therapy with |
and 2) follow-up |
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for |
surgery |
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either UFH or |
clinical data were |
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postoperative |
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enoxaparin |
not available |
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bleeding after |
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within 48 h |
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open-heart |
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before |
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surgery in |
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proceeding to |
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patients who |
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surgery |
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present with |
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an ACS: |
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clinical |
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investigation |
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and reports. |
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2002 (276) |
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Effects of |
To investigate |
Retrospectiv |
161 |
CABG patients |
Not CABG |
Bleeding |
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Compared with |
p<0.05 |
N/A |
LMWH given <12 h |
N/A |
preoperative |
the effects of |
e |
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patients |
events |
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UFH group, |
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increased the |
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enoxaparin |
LMWH on |
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LMWH, <12 group |
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transfusion rate and |
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vs. UFH on |
bleeding |
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had higher |
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number of PRBC |
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bleeding |
indices and |
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transfusion rate |
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transfused per patient |
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indices in |
transfusion |
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(73.5% vs. 50.7%, |
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patients |
rates in |
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respectively), |
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undergoing |
patients |
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CABG. 2003 |
undergoing |
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(277) |
cardiac |
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surgery |
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Preoperative |
To investigate |
Retrospectiv |
64 |
CABG patients |
Not CABG |
Bleeding |
N/A |
62% of pts |
p=0.8 |
N/A |
LMWH given <10 h |
Number of patients |
use of |
if the use of |
e |
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patients |
events |
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transfused in the |
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does not increase the |
receiving LMWH was |
enoxaparin is |
LMWH |
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LMWH vs. 60% in |
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transfusion rate and |
only 21. High transfusion |
not a risk |
increased the |
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the control |
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number of PRBC |
rate in the control group. |
factor for |
risk of |
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transfused per patient |
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postoperative |
bleeding in |
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bleeding after |
CABG |
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CABG. 2003 |
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(278) |
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© American College of Cardiology Foundation and American Heart Association, Inc.
ACS indicates acute coronary syndrome; CABG, coronary artery bypass graft; CI, confidence interval; h, hour; HR, hazard ratio; LMWH, low molecular weight heparin; MI, myocardial infarction; N, number; N/A, not applicable; OR, odds ratio; PLT, platelet inhibitors; PRBC, packed red blood cells; RR, relative risk; UFH, unfractionated heparin; and UA, unstable angina.
Data Supplement 41. Perioperative Bleeding/Transfusion
Article Title |
Aim of Study |
Study |
Patient |
Patient Population/Inclusion & Exclusion |
Endpoints |
Statistical Analysis |
95% CI; |
OR/HR/ |
Study Summary |
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Type |
Size |
Criteria |
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Reported |
P-Values |
RR |
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Inclusion Criteria |
Exclusion Criteria |
Primary |
Secondary |
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Endpoint |
Endpoint |
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A |
To compare |
RCT |
50 |
Patients who were |
An age of <30 y or >80 |
Graft patency |
Clinical outcomes |
Patients in the on-pump |
p=0.004 |
N/A |
N/A |
randomized |
graft-patency |
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referred for |
y; an indication for |
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group were more likely to |
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comparison |
rates and |
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isolated, first-time |
additional surgical |
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receive packed-cell |
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of off-pump |
clinical |
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coronary-artery |
procedures; |
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transfusion (p=0.004) or |
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and on- |
outcomes in |
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surgery and who |
documented stroke |
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clotting-product |
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pump multi- |
off-pump |
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required at least 3 |
within the preceding 6 |
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transfusion (p=0.002). The |
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vessel |
surgery with |
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grafts were |
mo; carotid-artery |
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mean blood loss was not |
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CABG. |
conventional, |
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eligible. |
stenosis of more than |
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significantly different |
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2004 (279) |
"on-pump" |
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70%; documented MI |
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between the 2 groups (898 |
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surgery. |
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in the preceding 3 mo; |
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mL in the on-pump group |
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poor LV function, with |
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and 1,031 mL in the off- |
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an EF <20%; |
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pump group). |
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pregnancy and breast- |
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feeding; an inability to |
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provide written |
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informed consent; and |
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a history of |
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complications after |
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diagnostic |
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angiography. |
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Early |
To compare |
Random |
281 |
Patients were |
Patients were excluded |
Cardiac |
Improvement in |
The intraoperative use of |
95% CI: |
N/A |
Concluded that in |
outcome |
the short term |
ized |
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eligible if referred |
in case of emergency or |
outcome 1 mo |
quality of life at 1 |
blood products was |
4 to 17; |
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selected patients, off- |
after off- |
clinical |
Multice |
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for first-time |
concomitant major |
after surgery |
mo. |
reduced in the off-pump |
p<0.01 |
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pump CABG is safe |
pump vs. |
outcomes of |
nter |
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isolated coronary |
surgery, Q-wave MI in |
(defined as |
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group. The proportion of |
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and yields a short-term |
on-pump |
OPCAB with |
Trial |
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bypass surgery and |
the previous 6 w, or |
survival free of |
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patients in whom blood |
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cardiac outcome |
coronary |
standard on- |
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an off-pump |
poor LV function or if |
CV events, |
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products were used during |
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comparable to that of |
bypass |
pump CABG. |
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procedure was |
they were unlikely to |
which included |
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surgery was almost 4 times |
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on-pump CABG. |
surgery: |
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deemed technically |
complete 1 y of follow- |
stroke, MI, and |
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lower in the off-pump |
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results from |
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feasible. |
up or unable to give |
coronary |
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group (3% for OPCAB vs. |
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a |
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informed consent. |
intervention). |
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13% for on-pump CABG, |
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randomized |
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There were no |
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p<0.01). |
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study. 2001 |
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restrictions as to age. |
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(280) |
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© American College of Cardiology Foundation and American Heart Association, Inc.
Early and |
To pool the |
Pooled |
401 |
Patients |
Recent MI within 1 |
The primary |
Noncardiac events, |
Analyses of combined data |
95% CI: |
RR: 0.36 |
In general, study |
midterm |
results of 2 |
outcom |
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undergoing off- |
mo; had a history of |
endpoint for this |
such as chest or |
from both trials showed |
0.26 to |
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concluded off-pump |
outcome |
RCT to assess |
e of 2 |
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pump or on-pump |
supraventricular |
pooled analysis |
wound infection, and |
transfusion of red blood |
0.51;p<0. |
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coronary surgery |
after off- |
midterm |
RCT |
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CABG. |
arrhythmia; had a |
was all cause |
neurological events. |
was 31% lower in OPCAB |
0001 |
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significantly lowers in- |
pump and |
outcomes of |
(which |
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previous CABG; had |
mortality or a |
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pages compared to on- |
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hospital morbidity |
on-pump |
OPCAB. |
compar |
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renal or respiratory |
cardiac-related |
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pump CABG. |
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without compromising |
surgery in |
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ed short |
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impairment; or had a |
event at |
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outcome in the first 1 to |
Beating |
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term |
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previous stroke, TIA, |
midterm follow- |
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3 y after surgery |
Heart |
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morbidi |
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or coagulopathy |
up (1 to 3 y after |
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compared with |
Against |
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ty of |
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present. |
surgery). |
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conventional on-pump |
Cardioplegic |
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OPCAB |
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coronary surgery. |
Arrest |
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vs. on- |
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Studies |
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pump |
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(BHACAS1 |
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CABG) |
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and 2): a |
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to |
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pooled |
|
assess |
|
|
|
|
|
|
|
|
|
analysis of 2 |
|
midterm |
|
|
|
|
|
|
|
|
|
RCTs. 2002 |
|
outcom |
|
|
|
|
|
|
|
|
|
(222) |
|
es. |
|
|
|
|
|
|
|
|
|
OPCAB |
To compare |
RCT |
200 |
Patients referred |
Patients in cardiogenic |
Completeness of |
In-hospital and 30-d |
Patients undergoing |
p=0.0073 |
OR: 2.42 |
In general, when |
grafting |
completeness |
|
|
for elective |
shock and those |
revascularizatio |
outcomes, LOS, |
OPCAB received fewer |
|
|
compared with |
provides |
of |
|
|
primary CABG |
requiring preoperative |
n. |
transfusion |
units of blood, were more |
|
|
conventional CABG |
complete |
revascularizati |
|
|
|
IABP counterpulsation |
|
requirements, and |
likely to avoid transfusion |
|
|
with CPB, OPCABG |
revasculariz |
on, clinical |
|
|
|
were excluded from the |
|
extent of myocardial |
altogether and had a higher |
|
|
achieved similar |
ation with |
outcomes, and |
|
|
|
study for cardiac |
|
injury. |
hematocrit at discharge. |
|
|
completeness of |
reduced |
resource use in |
|
|
|
reasons. Patients who |
|
|
CPB was an independent |
|
|
revascularization, |
myocardial |
unselected |
|
|
|
had chronic renal |
|
|
predictor of transfusion |
|
|
similar in-hospital and |
injury, |
patients |
|
|
|
insufficiency with a |
|
|
(OR: 2.42; p=0.0073) by |
|
|
30-d outcomes, shorter |
transfusion |
referred for |
|
|
|
creatinine level greater |
|
|
multivariate analysis. |
|
|
LOS, reduced |
requirements |
elective, |
|
|
|
than 2.5 mg/dL were |
|
|
|
|
|
transfusion |
, and LOS: a |
primary |
|
|
|
eligible for enrollment |
|
|
|
|
|
requirement, and less |
prospective |
CABG |
|
|
|
in the study but were |
|
|
|
|
|
myocardial injury. |
randomized |
randomly |
|
|
|
exempt from having |
|
|
|
|
|
|
comparison |
assigned to |
|
|
|
postoperative cardiac |
|
|
|
|
|
|
of 200 |
undergo |
|
|
|
angiography |
|
|
|
|
|
|
unselected |
OPCAB with |
|
|
|
performed. |
|
|
|
|
|
|
patients |
an Octopus |
|
|
|
|
|
|
|
|
|
|
undergoing |
tissue |
|
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|
|
|
off-pump vs. |
stabilizer |
|
|
|
|
|
|
|
|
|
|
conventional |
(Medtronic, |
|
|
|
|
|
|
|
|
|
|
coronary |
Inc, |
|
|
|
|
|
|
|
|
|
|
artery |
Minneapolis, |
|
|
|
|
|
|
|
|
|
|
© American College of Cardiology Foundation and American Heart Association, Inc.
bypass |
Minn) or |
|
|
|
|
|
|
|
|
|
|
grafting |
CABG with |
|
|
|
|
|
|
|
|
|
|
(281). |
CPB. |
|
|
|
|
|
|
|
|
|
|
Complete |
To evaluate |
RCT |
80 |
Inclusion criteria |
Diffuse disease, |
Completeness of |
Parameters of |
Although no significant |
p=NS |
N/A |
In general, the study |
revasculariz |
the feasibility |
|
|
were a normal or |
ventricular |
revascularizatio |
clinical outcome |
differences in bleeding |
|
|
concluded OPCAB is |
ation in |
of CABG |
|
|
almost unimpaired |
hypertrophy, and |
n |
|
complications were |
|
|
effective for complete |
coronary |
without CPB |
|
|
LVEF and |
cardiac enlargement |
|
|
reported, 1 (2.5%) |
|
|
revascularization in the |
artery |
to achieve |
|
|
presence of |
|
|
|
reexploration occurred |
|
|
majority of selected |
bypass |
complete |
|
|
coronary |
|
|
|
because of bleeding in a |
|
|
low-risk patients, |
grafting with |
revascularizati |
|
|
multivessel |
|
|
|
patient without CPB and 2 |
|
|
although the rate of |
and without |
on as |
|
|
disease. |
|
|
|
(5.0%) reexplorations |
|
|
incomplete |
CPB. 2001 |
compared with |
|
|
|
|
|
|
occurred in patients with |
|
|
revascularization in this |
(282) |
the standard |
|
|
|
|
|
|
CPB. |
|
|
early series of CABG |
|
operation with |
|
|
|
|
|
|
|
|
|
without CPB was |
|
CPB in |
|
|
|
|
|
|
|
|
|
higher. |
|
selected low- |
|
|
|
|
|
|
|
|
|
|
|
risk patients. |
|
|
|
|
|
|
|
|
|
|
Does |
To determine |
Meta- |
3,369 |
Studies were |
Hybrid (i.e., OPCAB |
All-cause |
Postoperative |
OPCAB significantly |
95% CI: |
OR: 0.43 |
In general, selected |
OPCAB |
whether |
Analysi |
|
included if they |
plus balloon |
mortality at 30 |
incidence of stroke, |
decreased transfusion |
0.29 to |
|
short-term and mid- |
reduce |
OPCAB |
s |
|
met each of the |
angioplasty) and |
d, 6 mon, and |
acute MI, AF, renal |
requirements. |
0.65; |
|
term clinical and |
mortality, |
reduces |
|
|
following |
robotically assisted |
>1 y. |
failure, need for |
|
p<0.0001 |
|
resource outcomes were |
morbidity, |
mortality, |
|
|
conditions: |
surgery studies were |
|
inotropes, need for |
|
|
|
improved compared |
and resource |
morbidity, or |
|
|
randomized |
excluded. |
|
intraaortic balloon |
|
|
|
with conventional |
utilization |
resource |
|
|
allocation to |
|
|
pump, |
|
|
|
CABG. |
when |
utilization |
|
|
OPCAB on the |
|
|
mediastinitis/wound |
|
|
|
|
compared |
when |
|
|
beating heart vs. |
|
|
infection, respiratory |
|
|
|
|
with |
compared with |
|
|
conventional |
|
|
infections, angina |
|
|
|
|
conventional |
standard |
|
|
CABG on the |
|
|
recurrence, |
|
|
|
|
coronary |
CABG. |
|
|
asystolic heart with |
|
|
reintervention for |
|
|
|
|
artery |
|
|
|
CPB circuit, adult |
|
|
ischemia, restenosis, |
|
|
|
|
bypass? A |
|
|
|
patients undergoing |
|
|
need for |
|
|
|
|
meta- |
|
|
|
singleor multiple- |
|
|
transfusions, |
|
|
|
|
analysis of |
|
|
|
vessel bypass, and |
|
|
reexploration for |
|
|
|
|
randomized |
|
|
|
reporting at least 1 |
|
|
bleeding, |
|
|
|
|
trials. 2005 |
|
|
|
pertinent clinical or |
|
|
neurocognitive |
|
|
|
|
(283) |
|
|
|
economic outcome. |
|
|
dysfunction, duration |
|
|
|
|
|
|
|
|
Off-pump studies |
|
|
of ventilation, ICU |
|
|
|
|
|
|
|
|
using minimally |
|
|
LOS, hospital LOS, |
|
|
|
|
|
|
|
|
invasive direct |
|
|
hospital costs, and |
|
|
|
|
|
|
|
|
coronary artery |
|
|
QOL. |
|
|
|
|
|
|
|
|
bypass with |
|
|
|
|
|
|
|
|
|
|
|
thoracotomy and |
|
|
|
|
|
|
|
© American College of Cardiology Foundation and American Heart Association, Inc.
|
|
|
|
studies allowing |
|
|
|
|
|
|
|
|
|
|
|
for ventricular |
|
|
|
|
|
|
|
|
|
|
|
assist devices were |
|
|
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|
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|
|
included with the |
|
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|
|
|
|
|
|
|
|
|
intent of |
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|
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|
|
subanalyzing these |
|
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|
|
|
|
|
|
|
|
|
groups. Blinded |
|
|
|
|
|
|
|
|
|
|
|
and unblinded |
|
|
|
|
|
|
|
|
|
|
|
studies were |
|
|
|
|
|
|
|
|
|
|
|
included. |
|
|
|
|
|
|
|
Impact of |
To evaluate |
Review |
N/A |
All blinded or |
Studies reporting on |
Blood loss. |
Transfusion |
N/A |
N/A |
N/A |
Evidence clearly |
off-pump |
current best |
article |
|
unblinded RCTs |
outcomes of hybrid |
|
requirements |
|
(values |
|
suggests that there is |
CABG on |
available |
on |
|
comparing OPCAB |
(i.e., OPCAB plus |
|
|
|
for |
|
less bleeding with off- |
postoperativ |
evidence from |
RCT's. |
|
or MIDCAB on the |
balloon angioplasty) |
|
|
|
individua |
|
pump procedures |
e bleeding: |
RCTs to assess |
|
|
beating heart with |
procedures, |
|
|
|
l studies |
|
compared with CPB |
current best |
the impact of |
|
|
conventional |
robotically assisted |
|
|
|
reported) |
|
and there is less need |
available |
OPCAB on |
|
|
CABG on CPB |
surgery or using |
|
|
|
|
|
for blood products. |
evidence. |
postoperative |
|
|
using cardioplegic |
circulatory assist |
|
|
|
|
|
|
2006 (284) |
blood loss and |
|
|
arrest, recruiting |
devices were excluded. |
|
|
|
|
|
|
|
transfusion |
|
|
adult patients |
|
|
|
|
|
|
|
|
requirements. |
|
|
undergoing single- |
|
|
|
|
|
|
|
|
|
|
|
or multiple-vessel |
|
|
|
|
|
|
|
|
|
|
|
bypass, and |
|
|
|
|
|
|
|
|
|
|
|
reporting at least 1 |
|
|
|
|
|
|
|
|
|
|
|
pertinent clinical or |
|
|
|
|
|
|
|
|
|
|
|
economic outcome |
|
|
|
|
|
|
|
|
|
|
|
were retrieved. Out |
|
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|
|
|
|
|
|
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|
|
of these, RCTs |
|
|
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|
|
reporting on |
|
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|
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|
|
postoperative blood |
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loss were included |
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|
for this systematic |
|
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|
|
|
|
|
|
review. |
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|
|
AF indicates atrial fibrillation; CI, confidence interval; CPB, cardiopulmonary bypass; CV, cardiovascular; EF, ejection fraction; HR, hazard ratio; IABP, intra aortic balloon pump; LOS, length of stay; LV, left ventricular; LVEF, left ventricular ejection fraction; MI, myocardial infarction; MIDCAB, minimally invasive directed coronary artery bypass; N/A, not applicable; OPCAB, off-pump coronary artery bypass; OR, odds ratio; QOL, quality of life;RCT, randomized controlled trial; and RR, relative risk..
© American College of Cardiology Foundation and American Heart Association, Inc.
Data Supplement 42. Perioperative Bleeding/Transfusion
Study |
Aim of |
Study Type |
Study |
Patient Population/Inclusion |
Endpoints |
Statistical Analysis Reported |
P Values & |
OR / HR |
Study Summary |
||
Name |
Study |
|
Size |
& Exclusion Criteria |
|
|
|
95% CI |
/ RR |
|
|
|
|
|
|
|
|
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|
|
|
|
|
|
|
|
|
Inclusion |
Exclusion |
Primary |
Secondary |
|
|
|
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|
|
|
|
Criteria |
Criteria |
Endpoint |
Endpoint |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Blood |
To define |
Comparison of |
1,261 |
Patients |
Patients not |
Incidence |
ICU and |
N/A |
p<0.001 |
N/A |
Adherence to defined transfusion |
conservatio |
strict |
prospective data |
|
undergoing |
undergoing |
of |
hospital LOS |
|
|
|
criteria alone is a simple, safe, and |
n in |
transfusion |
with retrospective |
|
isolated |
isolated |
postoperati |
and |
|
|
|
effective strategy for decreasing |
coronary |
criteria as the |
data (data is |
|
primary |
primary |
ve |
reoperation |
|
|
|
blood product utilization. |
artery |
sole blood |
regarding blood |
|
CABG. |
CABG. |
transfusion |
for bleeding. |
|
|
|
|
surgery. |
conservation |
product usage). |
|
|
|
. |
|
|
|
|
|
1994 (285) |
strategy. |
|
|
|
|
|
|
|
|
|
|
Efficacy of |
To determine |
RCT |
92 |
Adult men |
Patients |
Transfusio |
ICU blood |
Adherence to a coagulation |
p=0.0002 |
N/A |
ICU mediastinal blood loss was |
a simple |
if coagulation |
|
|
and |
undergoing |
n |
loss. |
test-based transfusion |
(for FFP |
|
significantly less in the algorithm |
intraoperati |
test-based |
|
|
nonpregnant |
nonelective |
requiremen |
|
algorithm in cardiac surgery |
transfusion); |
|
group. Multivariate analysis |
ve |
algorithms |
|
|
adult |
surgery or |
ts. |
|
patients with abnormal |
p=0.0001 |
|
demonstrated that transfusion |
transfusion |
may reduce |
|
|
women |
undergoing |
|
|
bleeding after CPB reduced |
(for platelet |
|
algorithm use resulted in reduced |
algorithm |
transfusion of |
|
|
scheduled |
surgery |
|
|
nonerythrocyte allogeneic |
transfusion) |
|
ICU blood loss. The control group |
for |
nonerythrocyt |
|
|
for elective |
without CPB. |
|
|
transfusions in the operating |
|
|
also had a significantly greater |
nonerythro |
e allogeneic |
|
|
cardiac |
|
|
|
room and ICU blood loss. The |
|
|
incidence of surgical reoperation of |
cyte |
blood in |
|
|
surgery |
|
|
|
transfusion algorithm group |
|
|
the mediastinum for bleeding |
component |
patients with |
|
|
requiring |
|
|
|
received less allogeneic fresh |
|
|
(11.8% vs. 0%; p=0.032). |
utilization |
abnormal |
|
|
CPB. |
|
|
|
frozen plasma in the operating |
|
|
|
after CPB. |
bleeding. |
|
|
|
|
|
|
room after CPB (median: 0 |
|
|
|
2001 (286) |
|
|
|
|
|
|
|
units; range: 0 to 7 units) than |
|
|
|
|
|
|
|
|
|
|
|
the control group (median: 3 |
|
|
|
|
|
|
|
|
|
|
|
units; range: 0 to 10 units) |
|
|
|
|
|
|
|
|
|
|
|
(p=0.0002). The median |
|
|
|
|
|
|
|
|
|
|
|
number of platelet units |
|
|
|
|
|
|
|
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|
|
|
transfused in the operating |
|
|
|
|
|
|
|
|
|
|
|
room after CPB was 4 (range: |
|
|
|
|
|
|
|
|
|
|
|
0 to 12) in the algorithm group |
|
|
|
|
|
|
|
|
|
|
|
compared with 6 (range: 0 |
|
|
|
|
|
|
|
|
|
|
|
to18) in the control group |
|
|
|
|
|
|
|
|
|
|
|
(p=0.0001). |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
© American College of Cardiology Foundation and American Heart Association, Inc.
Reduced |
Determine if |
Pilot study to |
60 |
Patients |
Patients not |
Reduced |
Chest tube |
Ten patients in the regular |
p<0.005 |
N/A |
Concluded that intraoperative |
haemostati |
the |
investigate the |
|
undergoing |
undergoing |
total |
output |
clinical group received a total |
|
|
monitoring of coagulation in the |
c factor |
heparinase- |
use of an |
|
cardiac |
cardiac |
exposure |
|
of 16 units of FFP and 9 |
|
|
anticoagulated patient can be used to |
transfusion |
modified |
algorithm. |
|
surgery. |
surgery. |
to |
|
platelet concentrates |
|
|
guide treatment. |
using |
thrombelasto |
|
|
|
|
hemostatic |
|
compared with 5 patients |
|
|
|
heparinase- |
gram using |
|
|
|
|
component |
|
transfused with 5 units of FFP |
|
|
|
modified |
anticoagulate |
|
|
|
|
therapies. |
|
and 1 platelet concentrate in |
|
|
|
thrombelas |
d blood from |
|
|
|
|
|
|
the algorithm group. 12-h |
|
|
|
tography |
patients |
|
|
|
|
|
|
chest tube losses [algorithm |
|
|
|
during |
during |
|
|
|
|
|
|
group 470 (295 to 820) mL, |
|
|
|
CPB. 2001 |
cardiac |
|
|
|
|
|
|
clinically managed group 390 |
|
|
|
(287) |
surgery could |
|
|
|
|
|
|
(240 to 820) ml (median, |
|
|
|
|
guide |
|
|
|
|
|
|
quartile values)] were not |
|
|
|
|
treatment |
|
|
|
|
|
|
significantly different between |
|
|
|
|
with |
|
|
|
|
|
|
groups despite the 3-fold |
|
|
|
|
haemostatic |
|
|
|
|
|
|
reduction in the use of |
|
|
|
|
components. |
|
|
|
|
|
|
haemostatic products, |
|
|
|
|
|
|
|
|
|
|
|
showing that intraoperative |
|
|
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|
|
|
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|
|
|
|
monitoring of coagulation in |
|
|
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|
|
|
|
|
|
|
|
the anticoagulated patient can |
|
|
|
|
|
|
|
|
|
|
|
be used to guide treatment. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
© American College of Cardiology Foundation and American Heart Association, Inc.
Compariso |
To test the |
RCT |
102 |
Sequential |
Patients with |
Postoperati |
Differences in |
The median blood loss was |
p<0.025 |
N/A |
Concluded that algorithms based on |
n of |
hypothesis |
|
|
patients for |
preoperative |
ve blood |
the POC test |
not significantly different |
|
|
POC tests or on structured clinical |
structured |
that a mgmt |
|
|
elective, |
abnormal |
loss and |
results |
among the groups in this |
|
|
practice with standard laboratory |
use of |
algorithm |
|
|
first time |
clotting tests, |
the |
between the |
study. Patients in the clinician |
|
|
tests do not decrease blood loss, but |
routine |
based on |
|
|
CABG |
including INR |
transfusion |
groups using |
discretion group received |
|
|
reduce the transfusion of PRBCs |
laboratory |
near-patient |
|
|
surgery with |
>1.5, APTT |
of PRBCs |
POC |
significantly more (p<0.025) |
|
|
and blood components after routine |
tests or |
tests would |
|
|
CPB treated |
ratio >1.5 or |
and blood |
hemostatic |
transfusions of blood |
|
|
cardiac surgery, when compared |
near- |
reduce blood |
|
|
by the same |
platelet count |
component |
assessment |
components (PRBCs, FFP and |
|
|
with clinician discretion. |
patient |
loss and |
|
|
surgical, |
<150 X 10 |
s |
and the group |
pooled platelets) compared |
|
|
|
assessment |
blood |
|
|
intensivist |
E(9)/litre, |
|
using |
with those in the LAG and |
|
|
|
with |
component |
|
|
and |
were |
|
standard |
POC groups. There were no |
|
|
|
clinical |
use after |
|
|
anaesthetic |
excluded. Any |
|
haematology |
significant |
|
|
|
judgment |
routine |
|
|
teams |
medication |
|
laboratory |
differences in this regard |
|
|
|
in the |
coronary |
|
|
|
affecting |
|
tests LAG. |
between the LAG and POC |
|
|
|
manageme |
artery surgery |
|
|
|
coagulation |
|
|
groups. |
|
|
|
nt of |
with CPB |
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|
|
within 72 h of |
|
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|
|
|
|
bleeding |
when |
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surgery, |
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after |
compared |
|
|
|
including |
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|
cardiac |
with an |
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|
|
warfarin, |
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|
|
surgery. |
algorithm |
|
|
|
heparin, low |
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|
|
2004 (288) |
based on |
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|
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molecular |
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routine |
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weight |
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|
laboratory |
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heparin, |
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assays or |
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aspirin and |
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|
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with clinical |
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|
|
clopidogrel, |
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|
|
|
judgment. |
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|
was also an |
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|
|
exclusion |
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criterion. |
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© American College of Cardiology Foundation and American Heart Association, Inc.