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[PMID]: | 27774838 |
[Au] Autor: | Myles PS; Smith JA; Forbes A; Silbert B; Jayarajah M; Painter T; Cooper DJ; Marasco S; McNeil J; Bussières JS; McGuinness S; Byrne K; Chan MT; Landoni G; Wallace S; ATACAS Investigators of the ANZCA Clinical Trials Network |
[Ad] Endereço: | From the Alfred Hospital (P.S.M., D.J.C., S. Marasco, S.W.) and Monash University (P.S.M., J.A.S., A.F., D.J.C., S. Marasco, J.M., S.W.), Melbourne, VIC, St. Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital, Adelaide, SA (T.P.) - all in Australia; South West Cardiac Centre, D |
[Ti] Título: | Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery. |
[So] Source: | N Engl J Med;376(2):136-148, 2017 01 12. | [Is] ISSN: | 1533-4406 |
[Cp] País de publicação: | United States |
[La] Idioma: | eng |
[Ab] Resumo: | BACKGROUND: Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. METHODS: In a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo coronary-artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after surgery. RESULTS: Of the 4662 patients who were enrolled and provided consent, 4631 underwent surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group. A primary outcome event occurred in 386 patients (16.7%) in the tranexamic acid group and in 420 patients (18.1%) in the placebo group (relative risk, 0.92; 95% confidence interval, 0.81 to 1.05; P=0.22). The total number of units of blood products that were transfused during hospitalization was 4331 in the tranexamic acid group and 7994 in the placebo group (P<0.001). Major hemorrhage or cardiac tamponade leading to reoperation occurred in 1.4% of the patients in the tranexamic acid group and in 2.8% of the patients in the placebo group (P=0.001), and seizures occurred in 0.7% and 0.1%, respectively (P=0.002 by Fisher's exact test). CONCLUSIONS: Among patients undergoing coronary-artery surgery, tranexamic acid was associated with a lower risk of bleeding than was placebo, without a higher risk of death or thrombotic complications within 30 days after surgery. Tranexamic acid was associated with a higher risk of postoperative seizures. (Funded by the Australian National Health and Medical Research Council and others; ATACAS Australia New Zealand Clinical Trials Registry number, ACTRN12605000557639 .). |
[Mh] Termos MeSH primário: |
Antifibrinolíticos/uso terapêutico Ponte de Artéria Coronária Hemorragia/prevenção & controle Complicações Intraoperatórias/prevenção & controle Ácido Tranexâmico/uso terapêutico
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[Mh] Termos MeSH secundário: |
Idoso Idoso de 80 Anos ou mais Antifibrinolíticos/efeitos adversos Aspirina/uso terapêutico Transfusão de Sangue/estatística & dados numéricos Doença da Artéria Coronariana/mortalidade Doença da Artéria Coronariana/cirurgia Método Duplo-Cego Feminino Valvas Cardíacas/cirurgia Hemorragia/induzido quimicamente Seres Humanos Masculino Meia-Idade Inibidores da Agregação de Plaquetas/uso terapêutico Complicações Pós-Operatórias/induzido quimicamente Reoperação/estatística & dados numéricos Convulsões/induzido quimicamente Trombose/induzido quimicamente Ácido Tranexâmico/efeitos adversos
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[Pt] Tipo de publicação: | JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T |
[Nm] Nome de substância:
| 0 (Antifibrinolytic Agents); 0 (Platelet Aggregation Inhibitors); 6T84R30KC1 (Tranexamic Acid); R16CO5Y76E (Aspirin) |
[Em] Mês de entrada: | 1701 |
[Cu] Atualização por classe: | 180222 |
[Lr] Data última revisão:
| 180222 |
[Sb] Subgrupo de revista: | AIM; IM |
[Da] Data de entrada para processamento: | 161025 |
[St] Status: | MEDLINE |
[do] DOI: | 10.1056/NEJMoa1606424 |
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