[HSF] More Bad News About Trasylol

[Ben Bidstrup]

>Ani,
>   As usual, great counterpoints.  I suppose you guys have brow  beaten me
>back into a position where I will still use aprotinin for cases at 
>particularly
>high risk for bleeding.  I will make a concerted effort to  counsel the
>patient about the use of the drug.  It still gives me the  creeps to 
>see lawyers'
>advertising "Did you suffer kidney failure after heart  surgery?  You may be
>entitled to compensation....."  Everything in  medicine is risk vs. 
>benefit.  I'm
>still very curious as to the subsequent  actions of the FDA. 
>   That study you suggested could certainly be done.  I'll have to  put it on
>my "to do" list.
>
>Hal


Do you call being made to assess the literature and look at evidence 
not anecdote as browbeating !
Mea culpa.

The study would be a little difficult as it would suffer the same 
limitations as Mangano. Comparing things done over 2 different time 
periods on the basis of retrospectively collected data - e.g. why did 
you do something, what were your indications for Trasylol then , 
might these have changed over time etc.
Not wanting to put you off though. Even a propensity analysis would 
be hard as you need to have a reasonable assumption that treatment 
assignment might be based on  non confounding co-variates - eg you 
have a similar number of dissections with and without a treatment.
The difficulty is that the law does not look at evidence quite in the 
same way we do. It is either balance of probability (civil)  or 
beyond reasonable doubt (criminal) if I recall correctly. It is how a 
judge perceives it on the day rather than the weight of evidence in 
the literature.

-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon