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Biomedical subjects

Jerry Avorn

Publications and source records attributed to Jerry Avorn.

At least 91 records · Page 5Linked to original sources
PubMed2003

Determinants of selective cyclooxygenase-2 inhibitor prescribing: are patient or physician characteristics more important?

BACKGROUND: Little is known about which factors influence the widespread use of selective cyclooxygenase (COX)-2 inhibitors. We examined the relative effects of patient risk factors for gastrointestinal toxicity, other patient characteristics, and physician prescribing preferences on the decision to prescribe a selective COX-2 inhibitor. METHODS: We retrospectively studied a cohort of 28,190 Medicare beneficiaries who were continuously enrolled in a large, state-run pharmacy benefits program that reimbursed for selective COX-2 inhibitors and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) without restrictions. Half of the study sample filled a prescription for a selective COX-2 inhibitor and the other half for a nonselective NSAID. Multivariable logistic regression models were developed to predict COX-2 inhibitor use. RESULTS: Seventeen percent of patients using a COX-2 inhibitor had no identifiable risk factor for NSAID-associated gastrointestinal toxicity, compared with 23% of those using a nonselective NSAID. Established risk factors (age > or =75 years, history of gastrointestinal hemorrhage or peptic ulcer disease, or concomitant warfarin or oral glucocorticoid use) were all significant predictors of COX-2 inhibitor use, but a multivariable model including only these risk factors discriminated poorly between the two patient groups (C statistic = 0.55). Adding other patient clinical and demographic characteristics to the model somewhat improved this association (C statistic = 0.66); however, when physician prescribing preference was included, the model had excellent ability to discriminate between the two treatment groups (C statistic = 0.83). CONCLUSION: Established risk factors for NSAID-associated gastrointestinal toxicity were poor predictors of who was prescribed a selective COX-2 inhibitor; in contrast, physician prescribing preference was an important determinant.

Aged↗
PubMed2003

Conversion from intravenous to oral medications: assessment of a computerized intervention for hospitalized patients.

BACKGROUND: Many hospitalized patients continue to receive intravenous medications longer than necessary. Earlier conversion from the intravenous to the oral route could increase patient safety and comfort, reduce costs, and facilitate earlier discharge from the hospital without compromising clinical care. We examined the effect of a computer-based intervention to prompt physicians to switch appropriate patients from intravenous to oral medications. METHODS: This study was performed at Brigham and Women's Hospital, an academic tertiary care hospital at which all medications are ordered online. We targeted 5 medications with equal oral and intravenous bioavailability: fluconazole, levofloxacin, metronidazole, ranitidine, and amiodarone. We used the hospital's computerized order entry system to prompt physicians to convert appropriate intravenous medications to the oral route. We measured the total use of the targeted medications via each route in the 4 months before and after the implementation of the intervention. We also measured the rate at which physicians responded to the intervention when prompted. RESULTS: The average intravenous defined daily dose declined by 11.1% (P =.002) from the preintervention to the postintervention period, while the average oral defined daily dose increased by 3.7% (P =.002). Length of stay, case-mix index, and total drug use at the hospital increased during the study period. The average total monthly use of the intravenous preparation of all of the targeted medications declined in the 4 months after the intervention began, compared with the 4 months before. In 35.6% of 1045 orders for which a prompt was generated, the physician either made a conversion from the intravenous to the oral version or canceled the order altogether. CONCLUSIONS: Computer-generated reminders can produce a substantial reduction in excessive use of targeted intravenous medications. As online prescribing becomes more common, this approach can be used to reduce excess use of intravenous medications, with potential benefits in patient comfort, safety, and cost.

Administration, Oral↗
PubMed2003

Internet marketing of herbal products.

CONTEXT: Passage of the Dietary Supplement Health and Education Act in 1994 restricted the Food and Drug Administration's control over dietary supplements, leading to enormous growth in their promotion. The Internet is often used by consumers as a source of information on such therapies. OBJECTIVE: To assess the information presented and indications claimed on the Internet for the 8 best-selling herbal products. DATA SOURCES: We searched the Internet using the 5 most commonly used search engines. For each, we entered the names of the 8 most widely used herbal supplements (ginkgo biloba, St John's wort, echinacea, ginseng, garlic, saw palmetto, kava kava, and valerian root). We analyzed the health content of all Web sites listed on the first page of the search results. STUDY SELECTION: We analyzed all accessible, English-language Web sites that pertained to oral herbal supplements. A total of 522 Web sites were identified; of these, 443 sites met inclusion criteria for the analysis. DATA EXTRACTION: The nature of the Web site (retail or nonretail), whether it was a sponsored link, and all references, indications, claims, and disclaimers were recorded. Two reviewers independently categorized medical claims as disease or nondisease according to Food and Drug Administration criteria. DATA SYNTHESIS: Among 443 Web sites, 338 (76%) were retail sites either selling product or directly linked to a vendor. A total of 273 (81%) of the 338 retail Web sites made 1 or more health claims; of these, 149 (55%) claimed to treat, prevent, diagnose, or cure specific diseases. More than half (153/292; 52%) of sites with a health claim omitted the standard federal disclaimer. Nonretail sites were more likely than retail sites to include literature references, although only 52 (12%) of the 443 Web sites provided referenced information without a link to a distributor or vendor. CONCLUSIONS: Consumers may be misled by vendors' claims that herbal products can treat, prevent, diagnose, or cure specific diseases, despite regulations prohibiting such statements. Physicians should be aware of this widespread and easily accessible information. More effective regulation is required to put this class of therapeutics on the same evidence-based footing as other medicinal products.

Advertising↗
PubMed2003

Economic consequences of routine coronary angiography in low- and intermediate-risk patients with unstable angina pectoris.

In low- and intermediate-risk patients with unstable angina pectoris (UAP) and non-ST-elevation acute myocardial infarction (NSTEAMI), routine early invasive management with coronary angiography does not decrease the risk of death or AMI. The economic consequences of this strategy in low- and intermediate-risk patients are unknown. We applied a risk prediction rule to a multihospital practice database and to the population of the Thrombolysis In Myocardial Ischemia trial, phase IIIB (TIMI 3B), which compared early invasive with conservative therapy for UAP and NSTEAMI. We then analyzed the effect of an early invasive strategy with regard to the composite end point of death, AMI, or rehospitalization for ischemia at rest. A logistic regression model was used to compare outcomes in patients with high versus low or intermediate risk scores. The costs and benefits of early invasive management in low- or intermediate-risk patients were assessed. In the practice database, 56% of patients with UAP and NSTEAMI who had low or intermediate risk scores underwent early cardiac catheterization, although early invasive management of these lower risk patients has not been associated with a reduction in the rate of death or MI. In TIMI 3B, when rehospitalization for ischemia at rest was added to the composite end point, invasive management was superior to conservative management at 42 days (p = 0.005) and at 1 year (p = 0.03). If all low- or intermediate-risk patients randomized to conservative therapy in that trial had been treated instead with an early invasive strategy, an estimated 5.4% of rehospitalizations would have been avoided. Within TIMI 3B, such a routine invasive strategy would have resulted in an additional cost of 2,695,700 US dollars with no effect on death or AMI, but it would have led to 34 fewer rehospitalizations. This expenditure of 79,285 US dollars per hospitalization prevented far exceeds the monetary cost of rehospitalization (14,000 US dollars). Although common in clinical practice, routine early invasive management of low- or intermediate-risk patients with UAP generates substantial health-care costs without a mortality benefit or decrease in the risk of AMI. Unless the incremental benefit in quality of life from prevented rehospitalizations for UAP is judged to be worth the large incremental cost (79,285 US dollars per hospitalization prevented), such a strategy is unlikely to be cost effective.

Aged↗
PubMed2003

Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer.

PURPOSE: Although clinical trials have clearly demonstrated the benefits of tamoxifen in women with primary breast cancer, little is known about how this drug is actually used in the general population. We sought to estimate adherence and predictors of nonadherence in women starting tamoxifen as adjuvant breast cancer therapy. PATIENTS AND METHODS: Subjects were age 18 years or older initiating tamoxifen for primary breast cancer and enrolled in New Jersey's Medicaid or Pharmaceutical Assistance to the Aged and Disabled programs during the study period, from 1990 to 1996 (N = 2,378). Main outcome measures were number of days covered by filled prescriptions for tamoxifen in the first year of therapy with the 4 years after tamoxifen initiation for a subset; predictors of good versus poor adherence. RESULTS: Twenty-three percent of patients missed taking tamoxifen on more than one fifth of days studied, although on average, patients filled prescriptions for tamoxifen for 87% of their first year of treatment. The youngest, oldest, nonwhite, and mastectomy patients had significantly lower rates of adherence; patients who had seen an oncologist before taking tamoxifen had significantly higher rates of adherence. Overall adherence decreased to 50% by year 4 of therapy. CONCLUSION: The mean level of adherence to tamoxifen is high compared with other chronic medications. However, nearly one fourth of patients may be at risk for inadequate clinical response because of poor adherence. Because of the efficacy of tamoxifen therapy in preventing recurrence and death in women with early-stage breast cancer, further efforts are necessary to identify and prevent suboptimal adherence.

Adult↗
PubMed2003

Arthritis self-management education programs: a meta-analysis of the effect on pain and disability.

OBJECTIVE: Some reports suggest that education programs help arthritis patients better manage their symptoms and improve function. This review of the published literature was undertaken to assess the effect of such programs on pain and disability. METHODS: Medline and HealthSTAR were searched for the period 1964-1998. The references of each article were then hand-searched for further publications. Studies were included in the meta-analysis if the intervention contained a self-management education component, a concurrent control group was included, and pain and/or disability were assessed as end points. Two authors reviewed each study. The methodologic attributes and efficacy of the interventions were assessed using a standardized abstraction tool, and the magnitude of the results was converted to a common measure, the effect size. Summary effect sizes were calculated separately for pain and disability. RESULTS: The search strategy yielded 35 studies, of which 17 met inclusion criteria. The mean age of study participants was 61 years, and 69% were female. On average, 19% of patients did not complete followup (range 0-53%). The summary effect size was 0.12 for pain (95% confidence interval [95% CI] 0.00, 0.24) and 0.07 for disability (95% CI 0.00, 0.15). Funnel plots indicated no significant evidence of bias toward the publication of studies with findings that showed reductions in pain or disability. CONCLUSION: The summary effect sizes suggest that arthritis self-management education programs result in small reductions in pain and disability.

Arthritis↗
PubMed2003

Hydroxyethyl starch and change in renal function in patients undergoing coronary artery bypass graft surgery.

BACKGROUND: Several case reports and clinical lore have suggested that exposure to the colloid hydroxyethyl starch may impair renal function, but few studies have systematically addressed this issue, and several have produced conflicting results. We sought to study the question in a formal analysis of postoperative change in renal function in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: We identified 238 consecutive patients who underwent CABG surgery at a large academic medical center. Glomerular filtration rate (GFR) was estimated using the Cockroft-Gault formula at baseline as well as on postoperative days 3 and 5. Linear regression analysis was used to study the relation between changes in GFR and intraoperative hydroxyethyl starch administration. Multivariate models controlled for potential demographic, clinical, and surgery-related confounders. RESULTS: Hydroxyethyl starch use was independently associated with a reduction in GFR on both postoperative days 3 and 5, with GFR declining by 7.2 mL/min/1.73 m2 on day 3 per unit of hydroxyethyl starch administered (95% CI, 1.7 to 12.7; P = 0.012), and by 6.6 mL/min/1.73 m2 on day 5 (95% CI, 1.2 to 11.9; P = 0.018). CONCLUSION: Intraoperative use of hydroxyethyl starch may be associated with modest impairment in renal function in patients undergoing CABG surgery. Randomized clinical trials will be necessary to confirm these findings and to further investigate their clinical implications.

Adult↗
PubMed2003

The nephrologist's role in the management of calcium-phosphorus metabolism in patients with chronic kidney disease.

BACKGROUND: In patients with chronic kidney disease (CKD), timely referral to a nephrologist has been shown to improve outcomes, but the specific care measures mediating these superior outcomes have not been sufficiently described. METHODS: In a cohort of 3014 patients with CKD, we evaluated whether they had any indicators of calcium-phosphorus metabolism management prior to renal replacement therapy (RRT). These included measurement of parathyroid hormone (PTH) or vitamin D metabolites, or receipt of calcitriol or calcium-containing phosphate binders (CCPB) prior to RRT. Control patients without such care were selected by risk-set matching. We used multivariate conditional logistic regression analysis to test whether use of these interventions was associated with prior nephrologist consultation. We then used Cox proportional hazards models to assess whether implementation of such care was associated with differences in 1-year mortality once RRT was instituted. RESULTS: Only 3.4% of CKD patients had their PTH assessed prior to RRT, and 0.3% had vitamin D status measured. Use of calcitriol (12.2%) and CCPBs (16%) was slightly more prevalent. Seeing a nephrologist was highly associated with use of the tests and drugs studied (odds ratio, 1.28 to 6.46; all P values <0.001), but care by generalists or other specialists was not. Management of calcium-phosphorus metabolism was independently associated with a 35% decreased likelihood of death (hazards ratio=0.65; 95%CI, 0.51 to 0.84) in the first year of RRT. CONCLUSION: Improvements in management of calcium-phosphorus metabolism in patients with CKD are attributable to nephrologist care and appear to mediate the survival benefit seen in patients who see a nephrologist relatively early in the course of their CKD.

Aged↗
PubMed2003

Chronic kidney disease as a risk factor for bleeding complications after coronary artery bypass surgery.

BACKGROUND: The aim of the study is to define the role of chronic kidney disease (CKD) as a risk factor for postoperative bleeding in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: This is a retrospective cohort study of 238 consecutive patients who underwent isolated CABG surgery. Patients were followed up for the event of a significant bleed, defined as administration of either three or greater units of packed red blood cells, three or greater units of platelets, three or greater units of fresh frozen plasma, or any cryoprecipitate within 72 hours after a CABG procedure or undergoing a surgical revision for bleeding. Glomerular filtration rate (GFR) at baseline was calculated using the Cockroft-Gault formula. A final multiple logistic regression model was selected from a large set of presurgical and intraoperative covariates by using backward elimination (P > 0.20). RESULTS: After controlling for age, sex, elective versus emergent surgery, intraoperative activated clotting time, serum albumin level, extracorporeal bypass time, and baseline hematocrit, we found that even mild levels of renal impairment were associated with increased risk for postoperative bleeding: patients with a GFR of 40 mL/min or less had six times the odds of postoperative bleeding than patients with a GFR greater than 100 mL/min (odds ratio [OR], 6.51; 95% confidence interval [CI], 1.87 to 22.66); those with a GFR of 41 to 60 mL/min had nearly four times the risk (OR, 3.87; 95% CI, 1.21 to 12.35). Even patients with mild CKD at a GFR of 61 to 80 mL/min were at an elevated risk (OR, 2.11); however, the 95% CI of 0.79 to 5.64 included the null value. Similar results were found when using the cruder Kidney Disease Outcomes Quality Initiative classification of CKD. CONCLUSION: CKD is associated with risk for postoperative bleeding in patients undergoing CABG surgery, not only at more advanced stages, but probably at relatively mild levels of renal impairment, as well.

Aged↗
PubMed2003

Multivariate predictors of blood product use in cardiac surgery.

OBJECTIVE: To determine factors associated with an increased risk of post-cardiopulmonary bypass (CPB) blood product usage in adult cardiac surgical patients. DESIGN: Prospective observational study. SETTING: Academic hospital. PARTICIPANTS: Patients undergoing cardiac surgery with CPB were studied over a 7-month period. INTERVENTIONS: The outcomes studied were receipt of more than 2 U of packed red blood cells (PRBCs), receipt of any other blood component products (cryoprecipitate, fresh-frozen plasma [FFP], or platelets), or surgical re-exploration for bleeding. Preoperative and intraoperative risk factors for bleeding were analyzed. MEASUREMENTS AND MAIN RESULTS: Increased age and preoperative creatinine level, low body surface area, preoperative hematocrit, nonelective surgery, lower temperature on bypass, and duration of bypass were associated with an increased risk of transfusion of >2 U of PRBCs. Low body surface area, repeat surgery, nonelective surgery, and CPB time were associated with transfusion of platelets, fresh-frozen plasma, or cryoprecipitate and/or surgical re-exploration. The following factors were associated with neither transfusion of more than 2 U of PRBC nor transfusion of platelets, FFP or cryoprecipitate, or surgical re-exploration: gender, preoperative international normalized ratio, preoperative antiplatelet medications, and preoperative intravenous heparin. CONCLUSION: Therapies aimed at reducing transfusion of blood products should be aimed at those patients with low body surface areas, baseline anemia, and those undergoing long or repeat surgeries.

Aged↗
PubMed2003

Pharmacoepidemiology and rheumatic diseases: 2001-2002.

Pharmacoepidemiology is the branch of epidemiology that focuses on medications and their outcomes, including both adverse events and intended consequences. Such studies have become more prominent in rheumatology as the number of new medications has grown and prescribing databases have become more available. In the past year, the potential cardiovascular complications associated with selective COX-2 inhibitors have become an important concern. A number of pooled analyses suggest the possibility of an increased risk of acute myocardial infarction, and studies of naproxen have found a possible protective effect. Accumulating evidence supports the contention that early initiation of disease modifying antirheumatid drug therapy improves outcomes of patients with rheumatoid arthritis. Open-label extensions of biologic therapies found continued benefits extending several years with the TNF-alpha antagonists, but concerns have arisen regarding tuberculosis and central nervous system demyelination with these agents. Data continue to be published quantifying the risk of osteoporosis associated with glucocorticoids, and the association between biphosphonate therapy and upper gastrointestinal events appears to be less of a concern that originally described.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

A propensity analysis of late versus early nephrologist referral and mortality on dialysis.

Previous studies have analyzed the association between late versus early nephrologist referral (LR, ER) and poor clinical outcomes in patients with end-stage renal disease. We sought to determine whether these poor outcomes were causally related to LR, or whether LR was a proxy for poorer access to health care in general. An inception cohort of incident dialysis patients enrolled in the New Jersey Medicare or Medicaid programs was identified. Using a large number of demographic, clinical, and health care utilization covariates, propensity scores (PS) were then calculated to predict whether a given patient had been seen by a nephrologist at 90 d before first dialysis. Cox proportional hazards models were then built to test the association between timing of nephrologist referral and mortality during the first year of dialysis, using PS adjustment and matching to determine whether this association was confounded by other measures of reduced healthcare utilization. Neither adjustment for PS (HR = 1.31; 95% CI, 1.17 to 1.47) nor matching (HR = 1.40; 95% CI, 1.23 to 1.59) materially changed the initial 36% excess mortality in LR compared with ER patients (HR = 1.36; 95% CI, 1.22 to 1.51). Excess mortality among LR was limited to the first 3 mo of dialysis (HR = 1.75; 95% CI, 1.48 to 2.08) but not present thereafter (HR = 1.03; 95% CI, 0.84 to 1.25). Late nephrologist referral is an independent risk factor for early death on dialysis, even after controlling for other indicators of healthcare utilization. Further research is needed to identify patients at particular risk so that interventions to prevent early deaths on dialysis in LR patients can be developed and tested.

Aged↗
PubMed2003

Trends in knee magnetic resonance imaging.

OBJECTIVE: To assess trends in knee magnetic resonance imaging (MRI) use and accompanying management changes to determine whether indications for this test have changed over time. DATA SOURCES: Large administrative database containing health care information for 587,010 people living in 1 state who were enrolled in the Medicare or Medicaid programs. They all had used health services during 3 consecutive years between 1991 to 1995. METHODS: We performed a retrospective cohort study examining the rates of lower extremity MRI in successive years and calculated the proportion of patients who were seen by a knee specialist or underwent knee surgery subsequent to the MRI. RESULTS: The annual rate of knee MRI was 1.4 per 1000 person-years in 1991 and increased by 140% to 3.4 per 1000 person-years by 1995 (P = 0.001). Approximately half of patients who underwent a knee MRI in 1991 had a diagnosis of internal derangement of the knee in the prior year; this figure dropped to 35% in 1995 (P < 0.001). The percentage of patients undergoing a knee MRI who had no record of any knee diagnosis in the prior year grew from 13% in 1991 to 33% in 1995 (P < 0.001). Over the 5 years of the study, the percentage of patients whose knee MRI was followed by specialist care or knee surgery decreased from 68% to 58%, a relative change of 15% (P < 0.005). CONCLUSION: Knee MRI use increased sharply during the study period, but the proportion of such patients who had a prior diagnosis of internal derangement or subsequently saw a knee specialist or underwent knee surgery decreased. This finding indicates that the criteria for knee MRI appear to have broadened substantially during this period.

Aged↗
PubMed2003

Economic consequences of underuse of generic drugs: evidence from Medicaid and implications for prescription drug benefit plans.

OBJECTIVE: To calculate the financial impact of underuse of generic medications in state Medicaid programs. DATA SOURCES/STUDY SETTING: State-by-state data on Medicaid drug spending for 48 states and the District of Columbia in calendar year 2000. STUDY DESIGN: We compared the total amount paid by each state Medicaid program for brand name prescriptions with the amount that would have been paid for generic versions of the same agent, to estimate the level of unrealized savings from use of substitutable generic drugs. We also examined whether variation in prices between states represented a potential source of unrealized savings. PRINCIPAL FINDINGS: Analysis of state-by-state Medicaid prescription drug spending in 2000 identified potential savings of $229 million that could have been realized from greater use of generic drugs. If the best available prices from each state had been used nationally, savings would have increased to $450 million. The majority of the unrealized savings were concentrated in a small group of medications, including clozapine, alprazolam, and levothyroxine. CONCLUSIONS: Federal regulations on prescription drug reimbursement limit the excess spending on brand name drugs in the Medicaid program to a small percentage of total spending, although the absolute dollar amount is large. Further savings could be realized if lowest available prices were used nationwide. Concentrating on specific agents may be a productive way to address the unrealized savings.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2003

Improved comorbidity adjustment for predicting mortality in Medicare populations.

OBJECTIVE: To define and improve the performance of existing comorbidity scores in predicting mortality in Medicare enrollees. DATA SOURCES: Study participants were two Medicare populations who had complete drug coverage either through Medicaid or a statewide pharmacy assistance program: New Jersey Medicare enrollees (NNJ, = 235,881) and Pennsylvania Medicare enrollees (NPA = 230,913). STUDY DESIGN: Frequently used comorbidity scores were computed for all subjects during the baseline year (January 1, 1994, to December 31, 1994, and one year later in Pennsylvania). The study outcome was one-year mortality during the following year. Performance of scores was measured with the c-statistic derived from multivariate logistic regression models. Empirical weights were derived in the New Jersey population and the performance of scores with new weights was validated in the Pennsylvania population. PRINCIPAL FINDINGS: A score based on ICD-9-diagnoses (Romano) performed 60 percent better than one based on patterns of medication use (Chronic Disease Score, or CDS-1) (c = 0.771 vs. c = 0.703). The performance of the Romano score was further improved slightly by inclusion of the number of different prescription drugs used during the past year. Modeling the 17 conditions included in the Romano score as separate binary indicators increased its performance by 8 percent (c = 0.781). We derived elderly-specific weights for these scores in the New Jersey sample, including negative weights for the use of some drugs, for example, lipid lowering drugs. Applying these weights, the performance of Romano and CDS-1 scores improved in an independent validation sample of Pennsylvania Medicare enrollees by 8.3 percent and 43 percent compared to the scores with the original weights. When we added an indicator of nursing home residency, age, and gender, the Romano score reached a performance of c = 0.80. CONCLUSIONS: We conclude that in epidemiologic studies of the elderly, a modified diagnosis-based score using empirically derived weights provides improved adjustment for comorbidity and enhances the validity of findings.

Aged↗
PubMed2003

Hetastarch and bleeding complications after coronary artery surgery.

STUDY OBJECTIVES: Controversy persists concerning the potential association between intraoperative use of hetastarch (ie, hydroxyethyl starch [HES]) and postoperative bleeding in patients undergoing surgery. To determine whether intraoperative HES use is associated with an increased risk of postoperative bleeding following coronary artery bypass graft (CABG) surgery. DESIGN: Case-control study. SETTING: A large academic medical center in the northeastern United States. PARTICIPANTS: A consecutive sample of 238 patients undergoing CABG surgery. MAIN OUTCOME MEASURES: Cases consisted of patients who had received either > or = 3 U packed RBCs, > or = 3 U platelets, > or= 3 U fresh frozen plasma, or any cryoprecipitate within 72 h after undergoing a CABG procedure, or who had undergone surgical revision for bleeding. All other CABG surgery patients served as control subjects. RESULTS: In multivariate models that controlled for a wide variety of demographic and clinical characteristics, we found that, compared to patients who did not receive any HES during surgery, those who received 1 U intraoperative HES had more than twice the risk of a bleeding outcome (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.10 to 4.91), and those who received 2 or 3 U HES had more than four times the risk of postoperative bleeding (OR, 4.57; 95% CI, 1.74 to 12.00). CONCLUSIONS: HES use in patients undergoing CABG surgery may be associated with a significant risk of postoperative bleeding. A double-blinded, randomized, controlled trial will be necessary to confirm this finding.

Adult↗