Abstract | OBJECTIVE: DESIGN: A retrospective observational study. PARTICIPANTS: A total of 870 adult cardiac surgery patients. INTERVENTION: MEASUREMENTS AND MAIN RESULTS: The authors evaluated perioperative patient characteristics in association with perioperative ischemic stroke and death. The patients were identified as heparin resistant if they had an activated coagulation time of <480 seconds after the administration of heparin at 400 to 500 U/kg. Heparin-resistant patients received a 10- to 20-mg bolus plus 25 to 50 mg/h of nafamostat mesilate and heparin at 100 U/kg intravenously every 1.5 to 2.0 hours to maintain an activated coagulation time over 480 seconds. Of the 870 patients, 11 (1.3%) suffered a perioperative ischemic stroke. Of the 190 (21.8%) patients who received nafamostat mesilate, 1 (0.5%) suffered ischemic stroke compared with 10 (1.5%) in 680 patients without nafamostat mesilate (Fisher exact test; p = 0.47; regression analysis; odds ratio, 0.35; 95% confidence interval, 0.45-2.8; p = 0.32); 3 (1.6%) patients with nafamostat mesilate died postoperatively within 30 days compared with 11 (1.6%) without nafamostat mesilate (Fisher exact test; p > 0.99, regression analysis; odds ratio, 0.98; 95% confidence interval, 0.27-3.5; p = 0.97). CONCLUSIONS:
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Authors | Mutsuhito Kikura, Keizo Tanaka, Takane Hiraiwa, Kuniyoshi Tanaka |
Journal | Journal of cardiothoracic and vascular anesthesia
(J Cardiothorac Vasc Anesth)
Vol. 26
Issue 2
Pg. 239-44
(Apr 2012)
ISSN: 1532-8422 [Electronic] United States |
PMID | 22019206
(Publication Type: Comparative Study, Journal Article)
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Copyright | Copyright © 2012 Elsevier Inc. All rights reserved. |
Chemical References |
- Benzamidines
- Guanidines
- Protease Inhibitors
- Heparin
- nafamostat
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Topics |
- Aged
- Benzamidines
- Brain Ischemia
(chemically induced, epidemiology)
- Cardiac Surgical Procedures
(adverse effects)
- Cardiopulmonary Bypass
(adverse effects)
- Cohort Studies
- Drug Resistance
(drug effects, physiology)
- Female
- Guanidines
(adverse effects, therapeutic use)
- Heparin
- Humans
- Male
- Middle Aged
- Perioperative Care
(adverse effects)
- Protease Inhibitors
(adverse effects, therapeutic use)
- Retrospective Studies
- Stroke
(chemically induced, epidemiology)
- Treatment Outcome
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