HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bruce D. Spiess Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Spiess, B. D. Search for Related Content PubMed PubMed Citation Articles by Spiess, B. D.

J Thorac Cardiovasc Surg 1999;118:765-766
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

Is a high hematocrit value an independent risk factor for adverse outcome after coronary artery bypass grafting?

Professor and Chief
Cardiothoracic Anesthesia
Virginia Commonwealth University
Medical College of Virginia
Richmond, VA 23298

Reply to the Editor:

My colleagues and I also believe that this article has the potential to change the way that cardiac operations are performed and particularly some of the transfusion habits surrounding those operations.

I wish to clarify the issue of aprotinin and other antifibrinolytic agents. Our study was conducted as an observational study in the very early 1990s, before the present day widespread use of aprotinin and antifibrinolytic drugs. Indeed, we are fortunate that this study was performed before the advent of the almost universal use of one or another of these agents. Our data showed that aprotinin was used in fewer than 10 patients in 2202 studied. Epsilon aminocaproic acid and tranexamic acid were used in fewer than 10% of patients. The data set did not contain detailed information regarding the dosage of lysine analog antifibrinolytic agents nor the exact timing of their use. When we examined this issue very early in the data analysis, we decided that the numbers were too few and the data too sketchy to include in the larger outcome analysis. With fewer than 10 patients receiving aprotinin, no effect could have been proved from the use of that drug. In our analysis we did not examine whether or not a patient received any of the antifibrinolytic agents (yes/no), and prevalence did not differ between outcome groups.

We do disagree with some of the statements made in Graham and O’Kane’s letter regarding the issues surrounding graft patency and myocardial infarction. That issue is extremely complex and the subject of great international debate. One should not conclude that aprotinin causes myocardial infarction, a hypercoagulable state, or an independent effect leading to a "bad outcome." It is not our wish to debate this point. However, a number of papers that provide an opposing view regarding these issues were not quoted by Graham and O’Kane.

In conclusion, the international debate regarding the effects of aprotinin and antifibrinolytic agents on myocardial infarction and graft patency is separate from the data and conclusions presented by our article.

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bruce D. Spiess Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Spiess, B. D. Search for Related Content PubMed PubMed Citation Articles by Spiess, B. D.