title: Antifibrinolytic use and bleeding during surgery on the descending thoracic aorta: a multivariate analysis.
abstract: OBJECTIVE
  The purpose of this study was to determine the potential benefit of antifibrinolytic (AF) therapy in improving hemostasis in descending aortic surgery in which extracorporeal distal perfusion is used.
  
  
  METHODS
  Retrospective database study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Seventy-two patients who underwent descending thoracic or thoracoabdominal aortic replacement during the period from January 1993 through December 1996 when the use of AF therapy was emerging.
  
  
  METHODS
  None.
  
  
  RESULTS
  Seventy-two records met criteria for inclusion. The use of AF therapy had no significant effect on any bleeding or transfusion outcome in any model. Excessive chest tube drainage postoperatively was independently associated with repeat surgery and intraoperative hypothermia. The risk of receiving a red blood cell (RBC) transfusion was independently predicted by low preoperative hemoglobin and age > or =65 years. Cross-clamp was an independent predictor of receiving a transfusion of non-RBC products (p = 0.03).
  
  
  CONCLUSIONS
  The authors could not show a beneficial effect of AF therapy on bleeding and transfusion, although current practice shows that this therapy continues to be used. Because heterogeneity of patient population exists and bias cannot be completely excluded, a prospective investigation evaluating efficacy and safety in this population is warranted.
authors.affiliation: Department of Anesthesiology, Mt. Sinai Medical Center, One Gustave L. Levy Place, Box 1010, New York, NY, USA. linda.shore@msnyuhealth.org
authors.forename: Linda
authors.initials: L
authors.lastname: Shore-Lesserson
authors.forename: Carol
authors.initials: C
authors.lastname: Bodian
authors.forename: Frances
authors.initials: F
authors.lastname: Vela-Cantos
authors.forename: George
authors.initials: G
authors.lastname: Silvay
authors.forename: David L
authors.initials: DL
authors.lastname: Reich
mesh_terms: D000368:Aged; D015119:Aminocaproic Acid / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D015119:Aminocaproic Acid