在冠状动脉旁路移植手术后的5年内,与阿普罗丁因相关的死亡率
Dennis T Mangano1, Yinghui Miao, Alain Vuylsteke
1Ischemia Research and Education Foundation, San Bruno, Calif 94066 , USA. dtb@iref.org
JAMA
|February 8, 2007
概括
在心脏手术中使用阿普罗丁因增加了长期死亡风险. 更安全的替代品,如氨基酸和酸,不显示这种增加的风险,使它们成为患者的首选选择.
科学领域:
- 心血管外科心血管外科
- 药理学 药理学是指药理学的学科.
- 临床结果研究研究
背景情况:
- 在心脏外科手术中,血液缓解药物的急性安全问题存在.
- 缺乏与这些药物相关的长期死亡率的综合数据.
研究的目的:
- 在冠状动脉旁路移植 (CABG) 手术患者的长期全因死亡率的比较,基于使用氨基甲酸,松酸,阿波丁素,或没有抗出血剂.
主要方法:
- 一项国际队列研究涉及3876名接受CABG手术的患者.
- 手术后5年的预期生存评估.
- 多变量分析与倾向调整,以比较药物对死亡率的影响.
主要成果:
- 与对照组 (12.7%) 相比,阿普罗丁尼的使用与5年死亡率 (20.8%) 的显著增加有关.
- 氨基甲酸 (15.8%) 和胺酸 (14.7%) 与长期死亡率的增加无关.
- 阿普罗丁因独立预测了5年死亡率,而其他药物没有.
结论:
- 在已知的急性安全性问题之外,阿普罗丁尼的使用增加了CABG手术后的长期死亡风险.
- 氨基卡普罗酸和甘酸是CABG患者用aprotinin的更安全,更便宜的替代品.
- 建议在CABG手术中避免使用aprotinin,因为它与长期死亡率的增加有关.
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