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Published on: May 28, 2019
Antiplatelet therapy preceding coronary artery surgery: implications for bleeding, transfusion requirements and
S M Picker1, T Kaleta, K Hekmat
1University of Cologne, Department of Transfusion Medicine, Cologne, Germany. susanne.picker@uk-koeln.de
Insights
Discontinuing antiplatelet therapy for at least 2 days before coronary artery bypass grafting reduces bleeding and transfusion needs. This strategy is recommended to improve patient outcomes after cardiac surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Post-cardiac surgery bleeding is a significant factor impacting patient morbidity and mortality.
- Antiplatelet medications are commonly used but may influence surgical outcomes.
Purpose of the Study:
- To evaluate the impact of pre-operative antiplatelet therapy on bleeding and transfusion rates in patients undergoing coronary artery bypass grafting (CABG).
Main Methods:
- A retrospective study comparing 40 patients on antiplatelet agents (aspirin, clopidogrel, ticlopidine) within 7 days of surgery to 40 control patients with no antiplatelet therapy for at least 8 days prior.
- Blood loss measured by chest-tube drainage in the first 12 hours post-surgery.
- Transfusion requirements (red cells, plasma, platelets) recorded intraoperatively and during ICU stay.
Main Results:
- Patients on antiplatelet therapy showed significantly higher rates of hemorrhage (940 mL vs. 412 mL) and transfusion requirements for red cells, plasma, and platelets (all P < 0.001).
- Lower creatine-kinase isoenzyme MB fractions and infarction rates were observed in the antiplatelet group, though not statistically significant for infarction.
- Increased bleeding and transfusion rates were most pronounced with short (≤2 days) or ongoing antiplatelet therapy cessation.
Conclusions:
- Discontinuation of antiplatelet therapy for a minimum of 2 days before elective coronary artery bypass grafting is advised to mitigate excessive blood loss and transfusion needs.
- Further investigation is warranted to determine if continuing antiplatelet therapy benefits high-risk patients susceptible to myocardial infarction.
Background And Objective:
Bleeding after cardiac surgery correlates with morbidity and mortality. The aim of this study was to determine the influence of antiplatelet therapy on bleeding and transfusion rates in coronary artery bypass grafting.
Methods:
Forty patients receiving aspirin and/or clopidogrel/ticlopidine within 7 days prior to surgery were retrospectively compared to 40 control patients lacking antiplatelet therapy for at least 8 preoperative days. Blood loss was assessed as chest-tube drainage during the first 12 h after surgery. Units transfused were recorded intraoperatively and during stay in the intensive care unit.
Results:
Both groups were comparable for pre- and intraoperative data. Irrespective of single or combined antiplatelet therapy, treated patients demonstrated lower fractions of the creatine-kinase isoenzyme MB (5.8 +/- 3.1 vs. 8.2 +/- 4.1%; P = 0.004) and infarction rates (0 vs. 3; P = 0.240) than control patients, but had significantly more haemorrhages (940 +/- 861 mL vs. 412 +/- 590 mL; P = 0.002) and transfusion requirements (red cells: 4.5 +/- 4.9 vs. 1.5 +/- 2.3, plasma: 4.9 +/- 6.4 vs. 1.3 +/- 2.5, platelets: 1.5 +/- 1.3 vs. 0.1 +/- 0.2; all P < or = 0.001). The differences to control patients were more pronounced for only short antiplatelet therapy free intervals or ongoing antiplatelet therapy (P < or = 2 days < or = 0.019). For antiplatelet therapy free intervals longer than 2 days, bleeding and transfusion rates (except for platelets) were nonsignificantly higher as compared to control patients (P > or = 0.058).
Conclusions:
To overcome increased blood loss and transfusion rates, antiplatelet therapy should be discontinued for at least 2 days before elective coronary surgery. Whether patients at high risk for myocardial infarction might benefit from ongoing antiplatelet therapy remains to be investigated.
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