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Antithrombotic therapy in cardiac surgery.

André Vincentelli¹, Brigitte Jude, Sylvain Bélisle

¹Centre Hospitalier Régional Universitaire de Lille, France.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie

|June 13, 2006

Summary

Perioperative antithrombotic therapy in cardiac surgery, especially during cardiopulmonary bypass (CPB), requires careful management. Current practices often rely on clinical experience rather than evidence-based guidelines.

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Area of Science:

Cardiovascular Surgery
Pharmacology
Thrombosis Management

Background:

Antithrombotic therapy is critical in cardiac surgery, encompassing procedures with and without cardiopulmonary bypass (CPB).
Management strategies must address anticoagulation during CPB and antiplatelet therapy post-surgery.

Purpose of the Study:

To review the perioperative management of antithrombotic therapy in cardiac surgery.
To examine the specific considerations for cardiopulmonary bypass (CPB) and off-pump surgery.

Main Methods:

A comprehensive review of English literature from 1975 to 2005.
Inclusion of international practices in antithrombotic therapy for cardiac surgery.

Main Results:

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Unfractionated heparin (UFH) is standard for anticoagulation during CPB, monitored by point-of-care (POC) tests with empirical target values.

Antiplatelet therapy is crucial post-coronary artery bypass grafting (CABG) to prevent ischemic events and improve graft patency.

Post-valvular surgery antithrombotic therapy requires individualized risk assessment; heparin-induced thrombocytopenia is a noted complication.

Conclusions:

Antithrombotic therapy is integral to cardiac surgery outcomes.
Evidence-based guidelines are lacking for much of perioperative antithrombotic management, except for antiplatelet use in CABG.