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Bridge to operation with the GPIIb/IIIa inhibitor abciximab in high-risk coronary patients
F Schoenhoff1, N Kayhan, G Thomas
1Department of Thoracic and Cardiovascular Surgery, University of Mainz, Mainz, Germany.
Insights
Glycoprotein-IIb/IIIa inhibitors like abciximab can be safely used before coronary bypass surgery. This approach improves hemodynamic outcomes in high-risk patients without increasing mortality or bleeding complications.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Glycoprotein-IIb/IIIa inhibitors are used in high-risk coronary patients undergoing surgery.
- There's no consensus on whether to stop these inhibitors before operation due to bleeding risks.
Purpose of the Study:
- To evaluate the safety and efficacy of using abciximab as a bridge to aorto-coronary bypass surgery.
- To assess the impact of abciximab on bleeding, hemodynamics, and mortality in high-risk coronary patients.
Main Methods:
- 140 patients undergoing primary aorto-coronary bypass for myocardial ischemia were studied.
- Patients received clopidogrel, aspirin, and heparin, with or without abciximab, until surgery.
Main Results:
- The abciximab group had higher intraoperative blood product needs but no significant difference in postoperative blood loss.
- Abciximab patients showed improved postoperative hemodynamic status.
- 30-day mortality was similar between groups (6.7% vs. 6.1% in controls).
Conclusions:
- Abciximab can be safely administered as a bridge to surgery in high-risk coronary patients.
- Using abciximab improves hemodynamic outcomes and reduces major ischemic events.
Background:
Glycoprotein-IIb/IIIa inhibitors are now frequently used in the cardiological treatment of high-risk coronary patients even if the patient is considered suitable for surgical intervention. However, there is no consensus whether GPIIb/IIIa inhibitors should be stopped before operation because of an increased risk of bleeding or if surgery should even be delayed until the anticoagulating effect subsides.
Methods:
From June 2002 to August 2003 140 patients who had to undergo primary aorto-coronary bypass for ongoing myocardial ischemia were enrolled in the present study. The patients received either clopidogrel, aspirin and heparin or additionally abciximab until operation.
Results:
Although the intraoperative need for blood products was higher in the abciximab group, there was no significant difference in postoperative blood loss. The hemodynamic situation of the abciximab patients after the operation was better compared to the other groups. 30-day mortality was not increased when compared to the elective control group (6.7 % vs. 6.1 %).
Conclusion:
The GPIIb/IIIa inhibitor abciximab can be safely used as a bridge to operation and results in a better hemodynamic outcome in high-risk coronary patients while reducing the incidence of major ischemic events.
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