Objective: We aimed to compare off-pump technique with on-pump technique on renal function in patients with non-dialysis-dependent renal dysfunction who underwent CABG.

Introduction: Preoperative non-dialysis-dependent renal dysfunction is a predictor of renal failure in patients undergoing CABG with CPB. Off-pump coronary revascularization has been shown to be less deleterious than on-pump bypass in patients.

Methods: The 94 patients with renal dysfunction undergoing isolated coronary artery bypass grafting were retrospectively analyzed. No patient was receiving dialysis. Patients were randomly assigned to conventional evascularization with CPB and beating heart. Both groups were compared in terms of renal dysfunction parameters and dialysis requirement. The logistic regression models were constructed to identify risk factors associated with dialysis requirement.

Discussion: Renal dysfunction requiring dialysis developed in 9 patients in the on-pump group. The measures analysis of variance was performed on the data that showed worsening of renal function in the on[1]pump group compared with the off-pump group. CPB is significant as independent predictor for the development of postoperative dialysis.

Conclusion: These results suggest that off-pump coronary revascularization offers a superior renal protection and has a significantly lower risk for renal complications in patients with non-dialysis-dependent renal dysfunction when compared with conventional coronary revascularization with CPB.

A recent cluster of patients presenting with idiopathic, severe, coagulopathy was reported in Illinois and traced to contaminated cannabinoids. The contaminating substance was determined to be brodifacoum, a potent, long acting, rodenticide that inhibits vitamin K dependent clotting factor production. Since the original reports from the Midwest, multiple additional cases have been reported in at least 11 states. Brodifacoum toxicity has now reached the proportions of a public health crisis. Patients can present with bruising, epistaxis, oropharyngeal and gum bleeding, excessive menstrual bleeding, hematemesis, hematuria, flank pain, or abdominal pain mimicking an acute abdomen. We present a case of brodifacoum toxicity that was rapidly reversed with parenteral Vitamin K and K-centra, four factor clotting concentrate. The use of intermittent prothrombin complex concentrates has the ability to control life threatening hemorrhage and is a potential important adjunctive treatment to minimize use of large doses of vitamin K.