What are the risks of N-acetylcysteine in perioperative anticoagulation management?

Updated: May 08, 2018
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: William A Schwer, MD  more...
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Answer

Answer

N-acetylcysteine is known to impair hemostasis when used for the prevention of perioperative inflammation and ischemia-reperfusion injury. Wijeysundera et al sought to determine whether N-acetylcysteine is associated with increased blood loss and blood product transfusion in 89 patients with preexisting moderate renal insufficiency undergoing cardiac surgery. [1] Another 88 patients received placebo.

The investigators found patients in the N-acetylcysteine group had a 261-mL greater mean 24-hour chest-tube blood loss and received 1.6 units more of red blood cell transfusions than the placebo group. [1] In addition, there was a significantly higher risk of receiving 5 or more units of red blood cells within 24 hours of surgery in the patients receiving N-acetylcysteine compared with the placebo group (P = 0.005). Wijeysundera et al therefore recommended clinicians and researchers consider the potential of impaired hemostasis in using N-acetylcysteine in the perioperative setting. [1]


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