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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Postoperative stroke in patients on oral anticoagulation undergoing coronary artery bypass surgery

Fausto Biancari1, Mikko Myllyl, Pekka Porela

  • 1Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it

Scandinavian Cardiovascular Journal : SCJ
|May 28, 2011
PubMed

Insights

Patients on warfarin undergoing coronary artery bypass grafting (CABG) face stroke risks. The CHADS(2) score and specific anticoagulation strategies predict postoperative stroke, guiding better patient management.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Pharmacology

Background:

  • Patients on long-term warfarin therapy have a high risk of stroke.
  • Coronary artery bypass grafting (CABG) surgery carries inherent risks, including postoperative stroke.
  • Identifying predictors of stroke in this high-risk population is crucial for improving outcomes.

Purpose of the Study:

  • To identify determinants of postoperative stroke in patients on long-term warfarin treatment undergoing CABG.
  • To evaluate the predictive value of logistic regression and classification and regression tree (CART) analyses for postoperative stroke.

Main Methods:

  • A consecutive series of 270 patients on long-term warfarin treatment undergoing isolated CABG were analyzed.
  • Logistic regression and CART analysis were employed to identify stroke predictors.
  • Receiver Operating Characteristic (ROC) curve analysis was used to assess predictive accuracy.

Main Results:

  • Postoperative stroke occurred in 3.7% of patients during in-hospital stay.
  • Logistic regression identified CHADS(2) score > 2, recent thrombolysis, and history of deep vein thrombosis as independent predictors.
  • CART analysis indicated CHADS(2) score > 2, history of stroke/transient ischemic attack (TIA), no preoperative aspirin, and bridging with low molecular weight heparins as risk factors.

Conclusions:

  • Patient characteristics within the CHADS(2) score are significant predictors of postoperative stroke risk after CABG.
  • Preoperative antiplatelet therapy may be beneficial for high-risk patients.
  • Preoperative bridging with low molecular weight heparins might increase stroke risk in this cohort.
Abstract

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