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Emergency coronary artery bypass grafting: does excessive preoperative anticoagulation increase bleeding
H Grubitzsch1, H G Wollert, L Eckel
1Heart and Diabetes Centre Mecklenburg-Vorpommern, Clinic of Cardiothoracic and Vascular Surgery, Karlsburg, Germany. grubitzsch@t-online.de
Insights
Extensive antithrombotic pretreatment before emergency coronary artery bypass grafting (CABG) does not increase perioperative risks. This approach may even offer benefits for patients with unstable coronary artery disease undergoing urgent revascularization.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Patients with unstable coronary artery disease often require urgent surgical revascularization.
- These patients are typically on multiple antithrombotic medications preoperatively.
- The perioperative risks associated with this intensive antithrombotic therapy are not fully understood.
Purpose of the Study:
- To investigate the perioperative risks of intensive antithrombotic pretreatment in patients undergoing emergency coronary artery bypass grafting (CABG).
Main Methods:
- A retrospective study of 123 patients undergoing emergency CABG.
- Group A (n=82) received heparin and aspirin.
- Group B (n=41) received additional ADP-receptor antagonists, glycoprotein IIb/IIIa inhibitors, or thrombolysis preoperatively.
Main Results:
- Demographics, clinical status, coagulation, and intraoperative characteristics were comparable between groups.
- No significant differences in blood loss, re-exploration rates, ICU/hospital stay, or perioperative mortality.
- Slight, non-significant increases in red blood cell and fresh frozen plasma transfusions were observed in Group B.
Conclusions:
- Intensive antithrombotic pretreatment appears safe in emergency CABG.
- This strategy may not confer additional perioperative risks and could be beneficial.
Abstract:
Patients requiring urgent surgical revascularization due to unstable coronary artery disease are usually pretreated with multiple antithrombotic drugs. The perioperative risks of this type of treatment were investigated in 123 patients who underwent emergency coronary artery bypass grafting (CABG) at our institution.Eighty-two patients (group A) received heparin and acetylsalicylic acid solely and 41 patients (group B) received additionally ADP-receptor antagonists (82.9%), glycoprotein IIb/IIIa inhibitors (12.2%) or thrombolysis (14.6%) preoperatively. Both groups were similar regarding demographic data and overall clinical status. Preoperative coagulation parameters and intraoperative characteristics were comparable. Blood loss via chest tubes was not significantly different between groups. Transfusion of red blood cells and fresh frozen plasma were slightly, but not significantly increased in group B. Transfusion of pooled platelets was low in general and similar in both groups. Re-exploration rate, medium intensive care unit and hospital stay as well as perioperative mortality were comparable.Excessive antithrombotic pretreatment seems to bear no additional risk in emergency CABG and may be beneficial in this setting.