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Surgical bleeding after pre-operative unfractionated heparin and low molecular weight heparin for coronary bypass
Giulia Renda1, Raffaele Di Pillo, Alberto D'Alleva
1Institute of Cardiology, G. d'Annunzio University, Chieti, Italy.
Insights
Enoxaparin is a safe alternative to unfractionated heparin (UFH) for bridging therapy in cardiac surgery patients who stop aspirin. Both treatments showed similar effects on coagulation and bleeding, with quick recovery.
Area of Science:
- Cardiology
- Pharmacology
- Hematology
Background:
- Aspirin discontinuation and heparin bridging are common before cardiac surgery to prevent bleeding.
- Evaluating enoxaparin and unfractionated heparin (UFH) as pre-operative bridging therapies is crucial.
Purpose of the Study:
- To assess the impact of pre-operative enoxaparin versus UFH on coagulation and bleeding in patients undergoing coronary artery bypass grafting (CABG) after aspirin discontinuation.
Main Methods:
- A randomized study of 43 patients undergoing elective CABG after aspirin discontinuation.
- Patients received either subcutaneous UFH or enoxaparin until 12 hours before surgery.
- Coagulation parameters (aPTT, Factor Xa activity), bleeding, and blood counts were monitored.
Main Results:
- Both enoxaparin and UFH similarly affected coagulation parameters, which normalized within 12 hours.
- Post-CABG hemoglobin, hematocrit, and platelet counts decreased similarly in both groups and re-normalized at the same rate.
- Transfusion requirements for blood and plasma were comparable between the enoxaparin and UFH groups.
Conclusions:
- Enoxaparin demonstrates safety and efficacy as a bridging therapy alternative to UFH for CABG patients discontinuing aspirin.
- The kinetics of coagulation parameters and bleeding indicate comparable safety profiles for both agents.
Background And Objectives:
Since the impairment of platelet function may cause excess peri-operative bleeding, pre-operative discontinuation of aspirin and heparin bridging are common for cardiac surgery. We evaluated the impact of pre-operative administration of enoxaparin and unfractionated heparin (UFH) on coagulation parameters and peri-operative bleeding in patients undergoing elective coronary artery bypass grafting (CABG) surgery after discontinuation of aspirin.
Design And Methods:
Forty-three patients with three-vessel coronary artery disease undergoing elective CABG surgery discontinued aspirin and were randomized to receive either UFH 180 UI/Kg x 2/day s.c. or enoxaparin 100 UI/Kg x 2/day s.c. until 12 h before surgery (median pre-operative treatment 8 days, range 6-12 days). Surgery was performed as usual with UFH. Neither UFH nor any low molecular weight heparin was given in the immediate post-operative period. The effects of UFH and enoxaparin were monitored by the activated partial thromboplastin time (aPTT) and the Enox-test (sensitive to factor Xa inhibition) using a Rapidpoint Coagulation Analyzer. aPTT and factor Xa activity were also measured by standard methods. Peri-operative bleeding and the nadirs of hemoglobin concentration, hematocrit and platelet count were monitored post-operatively.
Results:
Patients in the two groups were similar for number of bypasses, on-pump time, total surgery time, and time from the last heparin administration. Coagulation parameters increased significantly and similarly at 30 min and 6 h with both treatments, but returned within the normal range at 12 h. Hemoglobin, hematocrit and platelet counts significantly decreased to the same extent after CABG and re-normalized at the same time. Transfusional requirements of blood and plasma units were similar in the two groups.
Interpretation And Conclusions:
From the kinetics of coagulation parameters and the evaluation of bleeding, enoxaparin is a safe alternative to UFH as a bridging therapy to CABG after discontinuation of aspirin.
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