Document Detail


Intraoperative use of dextran is associated with cardiac complications after carotid endarterectomy.
MedLine Citation:
PMID:  23337295     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Although dextran has been theorized to diminish the risk of stroke associated with carotid endarterectomy (CEA), variation exists in its use. We evaluated outcomes of dextran use in patients undergoing CEA to clarify its utility.
METHODS: We studied all primary CEAs performed by 89 surgeons within the Vascular Study Group of New England database (2003-2010). Patients were stratified by intraoperative dextran use. Outcomes included perioperative death, stroke, myocardial infarction (MI), and congestive heart failure (CHF). Group and propensity score matching was performed for risk-adjusted comparisons, and multivariable logistic and gamma regressions were used to examine associations between dextran use and outcomes.
RESULTS: There were 6641 CEAs performed, with dextran used in 334 procedures (5%). Dextran-treated and untreated patients were similar in age (70 years) and symptomatic status (25%). Clinical differences between the cohorts were eliminated by statistical adjustment. In crude, group-matched, and propensity-matched analyses, the stroke/death rate was similar for the two cohorts (1.2%). Dextran-treated patients were more likely to suffer postoperative MI (crude: 2.4% vs 1.0%; P = .03; group-matched: 2.4% vs 0.6%; P = .01; propensity-matched: 2.4% vs 0.5%; P = .003) and CHF (2.1% vs 0.6%; P = .01; 2.1% vs 0.5%; P = .01; 2.1% vs 0.2%; P < .001). In multivariable analysis of the crude sample, dextran was associated with a higher risk of postoperative MI (odds ratio, 3.52; 95% confidence interval, 1.62-7.64) and CHF (odds ratio, 5.71; 95% confidence interval, 2.35-13.89).
CONCLUSIONS: Dextran use was not associated with lower perioperative stroke but was associated with higher rates of MI and CHF. Taken together, our findings suggest limited clinical utility for routine use of intraoperative dextran during CEA.
Authors:
Alik Farber; Tze-Woei Tan; Denis Rybin; Jeffrey A Kalish; Naomi M Hamburg; Gheorghe Doros; Philip P Goodney; Jack L Cronenwett;
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2013-01-18
Journal Detail:
Title:  Journal of vascular surgery     Volume:  57     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-28     Completed Date:  2013-04-18     Revised Date:  2014-04-14    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  635-41     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anticoagulants / administration & dosage,  adverse effects*
Chi-Square Distribution
Dextrans / administration & dosage,  adverse effects*
Endarterectomy, Carotid / adverse effects*,  mortality
Female
Heart Failure / chemically induced,  etiology*,  mortality
Humans
Intraoperative Care
Logistic Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / chemically induced,  etiology*,  mortality
New England
Odds Ratio
Plasma Substitutes / administration & dosage,  adverse effects*
Propensity Score
Registries
Risk Assessment
Risk Factors
Stroke / etiology,  prevention & control
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K08 HL105676/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Plasma Substitutes; K3R6ZDH4DU/Dextrans
Comments/Corrections
Comment In:
J Vasc Surg. 2013 Oct;58(4):1167-8   [PMID:  24075116 ]
J Vasc Surg. 2013 Oct;58(4):1167   [PMID:  24075115 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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