Change in practice from heparin to aspirin prophylaxis significantly reduced the thrombosis rate in renal paediatric recipients in a single centre
✍ Scribed by A. Al Midani; N. Rudarakanchana; S. Marks; J. Taylor; R. Lord
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 74 KB
- Volume
- 96
- Category
- Article
- ISSN
- 0007-1323
- DOI
- 10.1002/bjs.6521
No coin nor oath required. For personal study only.
✦ Synopsis
Objective: ESCT and NASCET established the role of CEA in appropriate patients but reported a 5-7% 30-day stroke/death risk. Strategies reducing this would be important. The GALA Trial was conceived following analysis of non-randomised and randomised studies suggesting a 50% risk reduction for LA CEA. Method: A total of 3526 patients (symptomatic or asymptomatic disease) were randomised to GA or LA (95 centres, 24 countries). Primary outcome events were stroke, myocardial infarction or death (randomisation -30 days post-surgery). The data were analysed by intention-to-treat analysis. Results: Events occurred (99•9% follow-up) in 84/1752 (4•8%) GA and 80/1771 (4•5%) LA patients (not significant: three events prevented per 1000 LA patients [95% CI -11, +17]; risk ratio 0•94 [95% CI 0•70, 1•27]). There were no differences for individual outcome events: stroke 70 (4•0%) GA versus 66 (3•7%) LA (three prevented per 1000 LA patients [95% CI -10 to +16]); death 26 (1•5%) GA versus 19 (1•1%) LA (four prevented per 1000 [95% CI -3 to +12]); myocardial infarction LA 9 (0•5%) versus GA 4 (0•2%) (three more per 1000 LA patients [95% CI -2 to +8]). In patients with contralateral carotid occlusion (pre-defined sub-group), outcome events occurred in 15/150 (10%) GA versus 8/160 (5%) LA, p = 0•098. Further 1-year survival data indicate fewer subsequent events (stroke, death, MI) in LA patients (p = 0•094). Conclusion: These data show that CEA outcomes have improved by up to a third since earlier trials and that both LA and GA are safe. For patients with contralateral carotid occlusion, LA might offer a benefit and trends suggesting improved 1-year survival following LA surgery require further analysis.