Antifibrinolytic agents and XXXX as hemostatic agents in cardiac surgery.

@entity1 @entity7062 @entity64 @entity548 @entity190 @entity7115 @entity927 @entity299 @entity583
OBJECTIVE: To review the use of systemic hemostatic medications for reducing @entity548 and transfusion requirements with cardiac surgery. DATA SOURCES: Articles were obtained through computerized searches involving MEDLINE (from 1966 to September 2000). Additionally, several textbooks containing information on the diagnosis and management of @entity548 associated with cardiac surgery were reviewed. The bibliographies of retrieved publications and textbooks were reviewed for additional references. STUDY SELECTION: Due to the large number of randomized investigations involving systemic hemostatic medications for reducing @entity548 associated with cardiac surgery, the article selection process focused on recent randomized controlled trials, metaanalyses and pharmacoeconomic evaluations. DATA EXTRACTION: The primary outcomes extracted from the literature were @entity190 and associated transfusion requirements, although other outcome measures such as mortality were extracted when available. DATA SYNTHESIS: Although the majority of investigations for reducing @entity299 and transfusion requirements have involved aprotinin, evidence from recent meta-analyses and randomized trials indicates that the synthetic antifibrinolytic agents, @entity7115 and @entity927 , have similar clinical efficacy. Additionally, @entity7115 (and to a lesser extent @entity927 ) is much less costly. More comparative information of hemostatic agents is needed retative to other outcomes (eg., reoperation rates, @entity583 , @entity64 ). There is insufficient evidence to recommend the use of @entity7062 for reducing @entity548 and transfusion requirements in cardiac surgery, although certain subsets of @entity1 may benefit from its use. CONCLUSIONS: Of the medications that have been used to reduce @entity548 and transfusion requirements with cardiac surgery, the antifibrinolytic agents have the best evidence supporting their use. @entity7115 is the least costly therapy based on medication costs and transfusion requirements.
