title: Intraoperative use of dextran is associated with cardiac complications after carotid endarterectomy.
abstract: OBJECTIVE
  Although dextran has been theorized to diminish the risk of stroke associated with carotid endarterectomy (CEA), variation exists in its use. We evaluated outcomes of dextran use in patients undergoing CEA to clarify its utility.
  
  
  METHODS
  We studied all primary CEAs performed by 89 surgeons within the Vascular Study Group of New England database (2003-2010). Patients were stratified by intraoperative dextran use. Outcomes included perioperative death, stroke, myocardial infarction (MI), and congestive heart failure (CHF). Group and propensity score matching was performed for risk-adjusted comparisons, and multivariable logistic and gamma regressions were used to examine associations between dextran use and outcomes.
  
  
  RESULTS
  There were 6641 CEAs performed, with dextran used in 334 procedures (5%). Dextran-treated and untreated patients were similar in age (70 years) and symptomatic status (25%). Clinical differences between the cohorts were eliminated by statistical adjustment. In crude, group-matched, and propensity-matched analyses, the stroke/death rate was similar for the two cohorts (1.2%). Dextran-treated patients were more likely to suffer postoperative MI (crude: 2.4% vs 1.0%; P = .03; group-matched: 2.4% vs 0.6%; P = .01; propensity-matched: 2.4% vs 0.5%; P = .003) and CHF (2.1% vs 0.6%; P = .01; 2.1% vs 0.5%; P = .01; 2.1% vs 0.2%; P < .001). In multivariable analysis of the crude sample, dextran was associated with a higher risk of postoperative MI (odds ratio, 3.52; 95% confidence interval, 1.62-7.64) and CHF (odds ratio, 5.71; 95% confidence interval, 2.35-13.89).
  
  
  CONCLUSIONS
  Dextran use was not associated with lower perioperative stroke but was associated with higher rates of MI and CHF. Taken together, our findings suggest limited clinical utility for routine use of intraoperative dextran during CEA.
authors: Section of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, MA, USA. Alik.Farber@bmc.org
authors: Alik
authors: A
authors: Farber
authors: Tze-Woei
authors: TW
authors: Tan
authors: Denis
authors: D
authors: Rybin
authors: Jeffrey A
authors: JA
authors: Kalish
authors: Naomi M
authors: NM
authors: Hamburg
authors: Gheorghe
authors: G
authors: Doros
authors: Philip P
authors: PP
authors: Goodney
authors: Jack L
authors: JL
authors: Cronenwett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003911:Dextrans / Q000008:administration & dosage / Q000009:adverse effects*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000139:chemically induced / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000139:chemically induced / Q000209:etiology* / Q000401:mortality; D009511:New England; D016017:Odds Ratio; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000009:adverse effects*; D057216:Propensity Score; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D003911:Dextrans; D010952:Plasma Substitutes