 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / General / Cardiology / January 2006Heart-surgery drug risky, researchers find
Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", San Jose Mercury News, January 26, 2006, Link: http://www.mercurynews.com/mld/mercurynews/living/health/13715800.htm A drug widely used during heart surgery to control bleeding doubles the risk of kidney damage, forcing an estimated 10,000 patients onto dialysis each year, according to a new study from a group that is calling for surgeons to abandon its use. Known as aprotinin, the drug also increases the risk of heart attack 48 percent, heart failure 109 percent and stroke 181 percent, according to a study among nearly 4,400 patients reported today in the New England Journal of Medicine. The researchers said the drug is not even needed in most cases because there are two generic drugs that cost a tenth as much and are nearly as good at stopping bleeding without increasing risks. ``I wonder how we can ethically prescribe aprotinin when there are alternatives that are safer,'' said Dr. Dennis Mangano of the Ischemia Research and Education Foundation, who led the study. The drug, which is derived from the lung tissue of cows, was approved by the Food and Drug Administration in 1993. It is used in a significant number of the 1 million heart surgeries performed worldwide each year. An FDA official said the agency is aware of the study and is reviewing the data. Bayer, which manufactures the drug and sells it under the brand name Trasylol, said in a statement that it had not yet analyzed the study, but that the results were not consistent with its own experience. > Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", San > Jose Mercury News, January 26, 2006, [quoted text clipped - 30 lines] > Trasylol, said in a statement that it had not yet analyzed the study, > but that the results were not consistent with its own experience. It is my understanding that aprotinin is administered following CABG, in order to reverse the anticoagulant effects of heparin. Heparin (an anticoagulant) inhibits the conversion of prothrombin to thrombin, the step just preceding formation of fibrin and stable platelet clot formation. During CABG, fairly large cumulative doses of heparin are required to prevent clot formation. Since the on-pump procedure exposes the patient's blood to a plastic reservior, pump filters and much tubing, the body's clotting cascade, natural immune and inflammatory repsonses are activated. All of these reactions can result in red blood cell destruction and other complications. This is one reason why minimally invasive cardiac surgery "MICS" (off-pump) is generally favored over on-pump procedures,IMO (when indicated). Since the blood is not exposed to large surface areas of foreign material, MISCS eliminates the need for heparin administration. Therefore heparin reversal is not required, and the need for aprotonin (or other similar drug) is avoided as well! In addition, the body's natural yet undesirable responses (such as complement activation, cytokine activation, activation of coagulation factors etc.) are minimzed as well. Just some additional thoughts. -Sue (non doctor) > > Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", San > > Jose Mercury News, January 26, 2006, [quoted text clipped - 62 lines] > > -Sue (non doctor) Please excuse my post. I was confusing protamine sulfate with aprotinin. Protamine suflate is used to reverse heparin effects in CABG procedures, not aprotonin. Please strike all of my comments that indicate aprotonin. I was referring to protamine sulfate. My sincere apologies, Sue (non doctor, thank goodness!) >> Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", San >> Jose Mercury News, January 26, 2006, [quoted text clipped - 49 lines] > (off-pump) is generally favored over on-pump procedures,IMO (when > indicated). you must be referring to MIDCAB....minimally invasive direct coronary bypass sugery.....which is NOT always "off pump" "off pump surgery" can be sternum splitting OR minimally invasive... the two are not totally interchangeable in MIDCAB the surgeons does NOT split the sternum...but works thru smaller incisions..usually several...to sew bypass grafts onto diseased coronaries "may be performed with or without use of the heart lung machine" limitations to MIDCAB ...only can be used in a very small subset of patients..usually those whose disease is limited to the LAD.... "beating heart" surgery..on the other hand...can be used on MOST patients..as long as the surgeon involved is skilled at the technique...approx 25% of bypass surgeries in the uS currently are off pump.... a "stabilizer" similar to a suction cup thingie ..is applied to the heart..and allows the immobilization of the area being operated on...it is quite a fascinating surgery to watch... recovery from any heart surgery NOT involving the bypass machine is quicker and has less risks ..such as "pump head" and risks of emboli etc ...blood flow thru the heart lung machine is VERY fast..and the blood cells can be damaged hubby had beating heart...tradiitional sternum splitting bypass...we even have a videotape of the procedure...he was in recovery room ..fully awake several hours after his surgery began (which took a tad less than 2 hours...3 grafts)...by 7pm night of surgery he was eating a turkey sandwich..home in 72 hours... > Since the blood is not exposed to large surface areas of foreign > material, MISCS eliminates the need for heparin administration. [quoted text clipped - 8 lines] > > -Sue (non doctor) > >> Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", San > >> Jose Mercury News, January 26, 2006, [quoted text clipped - 97 lines] > > > > -Sue (non doctor) Hi Hawke, I am sorry that I lumped all minimally invasive procedures under one umbrella. I was really thinking about the beating heart surgery. Years ago I supported some of the preclinical research that was used to bring this technology to premarket approval (our device is called the Octopus, lol). I was also involved in some CABG (pump devices) research (studying various coatings, like heparin-bonded for tubing, filters etc. These coatings help to reduce potential clotting etc. I am a little rusty in remembering the perfusion procedure now for CABG!! I think the beating heart surgery has fantastic advantages (but I am obviously biased) I am so happy to that your hubby has done well following the beating heart surgery. Best wishes, Sue (nondoctor) >> >> Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", San >> >> Jose Mercury News, January 26, 2006, [quoted text clipped - 115 lines] > bring this technology to premarket approval (our device is called the > Octopus, lol). ah...a Medtronic gal!! ours was by Guidant..and it was they who taped his surgery...for training purposes..his surgeon does a lot of surgeon training for Guidant > I was also involved in some CABG (pump devices) research (studying > various coatings, like heparin-bonded for tubing, filters etc. These [quoted text clipped - 3 lines] > CABG!! I think the beating heart surgery has fantastic advantages (but > I am obviously biased) hubby's entire career was in medical devices..no..not your company...but he knows lots of Medtronic folk...his devices all used in open heart surgery..always said "don't mind selling the stuff..but don't want to ever need to use it"... he was lucky that beating heart was available due to his grafting sites..also that such a great surgeon was nearby... > I am so happy to that your hubby has done well following the beating > heart surgery. thanks...he did great!!! 5 years post MI now..and failed stents...3 years post CABG...looks and feels better than ever...age 66 > Best wishes, > > Sue (nondoctor) > thanks...he did great!!! 5 years post MI now..and failed stents...3 years > post CABG...looks and feels better than ever...age 66 Was he very compliant with respect to diet, exercise and medication after the stents? Just wondering because I just had some stents put in and am wondering what the progression of the disease will be. Roland > > thanks...he did great!!! 5 years post MI now..and failed stents...3 years > > post CABG...looks and feels better than ever...age 66 [quoted text clipped - 4 lines] > Just wondering because I just had some stents put in and am wondering > what the progression of the disease will be. It would be wise to become lean and trim if you wish to arrest the progression of your coronary disease: http://www.HeartMDPhD.com/wtloss.asp Will be available to "glow" and chat about this and other things like cardiology, diabetes, cooking and nutrition that interest those following this thread here during the next on-line chat (02/02/06) from 6 to 7 pm EST: http://tinyurl.com/cpayh For those who are put off by the signature, my advance apologies for how the LORD has reshaped me: http://tinyurl.com/bgfqt Prayerfully in Christ's love, Andrew http://tinyurl.com/8juld > > thanks...he did great!!! 5 years post MI now..and failed stents...3 years > > post CABG...looks and feels better than ever...age 66 [quoted text clipped - 6 lines] > > Roland Roland, I did not mean to scare anyone when I said reocclusion is common. I really have no stats about how common this is. Keep in mind that I work in research, so we are always trying to improve outcomes. We are alwasy eharing about the failures.. not as much about the successes. There is a lot that a patient can do. >From what I hear, lifestyle changes are so important. For example, if a bad diet, smoking and other life choices speeded your CAD, a stent may provide only a temporary grace period, if those habits are not changed. I do not know what your case is, but it seems that Dr. Chung's advice is the best. CAD can be slowed down in many cases. Perhaps even arrested. Best of luck to you. -Sue >> thanks...he did great!!! 5 years post MI now..and failed stents...3 >> years >> post CABG...looks and feels better than ever...age 66 > > Was he very compliant with respect to diet, exercise and medication > after the stents? yes.... statistically about 40% of stents will re occlude...usually within 6 months... "unfortunately" if that is the right word..hubby NEVER had any angina..at any time..before or after ...yeah the MI was pain bigtime..but once the thrombylitic kicked it..all pain went away...he sorta thought he could go home!! stents were placed the next day... we feel it may have been the location and placement of the stents that contributed to their re occluding...3 placed nearly stem to stern...at the LAD right at the bifurcation..... > Just wondering because I just had some stents put in and am wondering > what the progression of the disease will be. > > Roland > >> >> Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", San > >> >> Jose Mercury News, January 26, 2006, [quoted text clipped - 146 lines] > > > > Sue (nondoctor) LOL. We are all in this together, I say. :-) I will bet your husband loved his job. I love working for a company like this (providing medical devices). Unfortunatley it seems stents have always had issues (reocclusion is so common). But my statement is just a broad sweeping generalization based upon "talk" I hear. I have no true stats on reocclusion rates. Hawke, I love hearing success stories. Thanks for sharing. I wish you and your husband many more years of health and prosperity! -Sue (non doctor) > >> Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", San > >> Jose Mercury News, January 26, 2006, [quoted text clipped - 97 lines] > > > > -Sue (non doctor) Guess my guys were not the best. Had a 4 way that took 7 hours on the pump. I got out of hospital in 2 days. Lots of drugs and had my wires for monitoring backwards. I was yelled at for jumping about two times. Leads were not right....remember that. Noticed the night folks and low level employes were not happy campers. Missed most of my doctor's who came to see me visits as I was out and about. Got chastised for walking up and down steps in the solarium for which I gave a censored response. Surgery guy gave me a teddy bear and a few weeks latter said you are doing fine. He hinted that the cardio follow up may be extensive. It was and obstinate me said obscenity this after four years. I can't handle statin's help due to muscle loss. Sucks Bill still about.  SignatureGarden Shade Zone 5 S Jersey USA This article is posted under fair use rules in accordance with Title 17 U.S.C. Section 107, and is strictly for the educational and informative purposes. This material is distributed without profit. Vision Problems? Look at http://www.ocutech.com/ ~us$1500 > > >> Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", San > > >> Jose Mercury News, January 26, 2006, [quoted text clipped - 122 lines] > and informative purposes. This material is distributed without profit. > Vision Problems? Look at http://www.ocutech.com/ ~us$1500 Bill, You made it through 7 hours on-pump. You are a tough dude. I am not sure why but I have this feeling that you were a premie... came out early.. kicking and screaming. Now you are still about, kicking and screaming. Keep it up :-) Look for the positives and keep moving forward. Best wishes, Sue PS Hey- You are not one of the night shift low level employess at the hospital. They might be in your shoes one day.. how would they take it? Woudl they keep kicking and fighting? You can be happy again Bill. You have the guts for it.,,, You have the guts for living, not just existing. Go for any gold ring you can find, and grab it. >> > >> Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", >> > >> San [quoted text clipped - 166 lines] > guts for living, not just existing. Go for any gold ring you can find, > and grab it. hmmm...one of the advantages of being a nurse ....nurses always know the best surgeons..and the best places...no kidding.. my sister works in cardiac rehab...and hubby's ex worked in the OR at the hospital he had his surgery...plus the surgeon's "nurse " was an old friend of over 20 years!!...yeah..it does pay to have inside info... just an example..hubby was determined to have his leg vein "harvested" via an endoscope...not the awful down the leg incisions,,,two days pre op..when we went in to the surgeon..same day he agreed to and met the guys who would videotape his procedure...we asked about getting the endoscopic harvest(we knew that hospital had the equipment)...nurse told us.."we have the scope,,,but the guy who used to run it has retired"...hmmm we said.."can't you find someone else to do the harvest??"....now..remember..we were doing this surgeon a favor by allowing the videotaping ...by late afternoon..the nurse called back ...she had "found a PA that worked with this surgeon at ANOTHER hospital"...and he was making a special trip to harvest hubby's vein using the endoscope...!!! "pulling strings??"...yep... ALL of the staff at this hospital were superb!!! being a nurse it is easy to evaluate excellent care (have had less than optimal care myself when hyster was done).... |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.