Antifibrinolytic agents and angiotensin-converting enzyme inhibitors: the effect on postoperative renal dysfunction in cardiac surgery
Bibliographic record
Abstract
To investigate the effect of the antifibrinolytic agents aprotinin and tranexamic acid on the occurrence of acute postoperative renal dysfunction in cardiac surgery on patients treated preoperatively with angiotensin-converting enzyme (ACE) inhibitors. A total of 7,420 patients who had undergone nonemergency coronary artery bypass graft or valve surgery in the Bristol Royal Infirmary from January 2000 until end of March 2006 were included in a retrospective observational study. The incidence of postoperative renal dysfunction was compared in patients given aprotin, tranexamic acid or no antifibrinolytic agent, using propensity-adjusted multivariable logistic regression. Further analysis was performed comparing patients taking ACE inhibitors preoperatively with those not taking ACE inhibitors. Renal dysfunction was defined as creatinine higher than 200 μmol/l and/or renal dialysis. Patients with a previous history of renal dysfunction were excluded from the study. Using propensity-adjusted multivariable logistic regression (C-index, 0.82), the use of aprotinin in patients taking ACE inhibitors was associated with more than doubling the risk of acute postoperative renal failure in patients undergoing nonemergency cardiac surgery (odds ratio 2.64; confidence interval 1.32–5.27). Tranexamic acid was also associated with a significant increase in the risk of renal failure (odds ratio 1.59; confidence interval 1.09–2.31) in patients taking ACE inhibitors. However, in this study, there was no association between either aprotinin (odds ratio 1.01) or tranexamic acid (odds ratio 1.19) and postoperative renal failure in patients not taking ACE inhibitors. In cardiac surgery, there is a significant association between use of the antifibrinolytic drugs aprotinin and tranexamic acid and the occurrence of acute postoperative renal dysfunction, in patients taking ACE inhibitors. The potential blood-saving benefits of antifibrinolytic drugs should be weighed up against this serious postoperative complication.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".