Ocean State Clinical Coordinating Center
Publications
AC Kalil , S Puumala, J Stoner. Unresolved questions with the use of linezolid versus vancomycin for nosocomial pneumonias. Chest. 2004;125(6):2370-1
Abstract
laboratory parameters indicative of blood loss would have been
more reliable estimates of perioperative blood loss. These indicators
should be considered as one of the primary outcome
variables. Although transfusions may reflect bleeding, previous
data15,16 suggest that transfusing blood in cardiac surgery is
behavioral rather than a response to blood loss. Re-operation
(exploration for bleeding) in coronary bypass surgery cannot be
used as a measure of drug-induced coagulopathy unless one completely
excludes other causes for bleeding, ie, heparin-protamine
activity, large-vessel bleeding, and overall patient coagulation status.
Simple changes in preoperative, intraoperative, and postoperative
hemoglobin and hematocrit values would help clarify their claims,
although even these are confounded by volume changes.
The patients selected in the study by Avorn et al1 were those
who had received 3 U packed RBCs within 72 h after undergoing
CABG procedure; all other CABG patients were control subjects.
The higher comorbidity in the cases (HES group) may act as a
confounder leading to higher transfusion rates as a result of lower
transfusion thresholds for more severely ill patients.
The editorial accompanying this study recommends a change
in practice without convincing evidence. Lack of sufficient data
should not be replaced with personal interpretation of study results.
This invariably can be misleading to the medical community
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