Postoperative Bleeding Following Preoperative Clopidogrel Administration in Patients with Haemoglobin Level Above 110 g/L Undergoing Urgent CABG
Abstract Introduction: Patients with acute coronary syndrome usually receive dual antiplatelet therapy (DAPT) (usually clopidogrel + aspirin) prior to coronary catheterization, and approximately 10% of these patients require coronary artery bypass grafting (CABG). DAPT has favorable effects on prev...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Cirurgia Cardiovascular
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| Series: | Brazilian Journal of Cardiovascular Surgery |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382018000100059&lng=en&tlng=en |
| _version_ | 1818232051172638720 |
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| author | Sasa Milan Kacar Aleksandar Mikic Mirjana Božidar Kačar |
| author_facet | Sasa Milan Kacar Aleksandar Mikic Mirjana Božidar Kačar |
| author_sort | Sasa Milan Kacar |
| collection | DOAJ |
| description | Abstract Introduction: Patients with acute coronary syndrome usually receive dual antiplatelet therapy (DAPT) (usually clopidogrel + aspirin) prior to coronary catheterization, and approximately 10% of these patients require coronary artery bypass grafting (CABG). DAPT has favorable effects on prevention of thrombus formation, but it can have deleterious effects on surgical hemostasis. Anaemia, if present, gives additional risk to such patients. The aim of this study was to examine if DAPT affects postoperative bleeding in patients with haemoglobin levels above 110 g/L, who underwent urgent or emergent CABG, less than five days after stopping DAPT therapy. Methods: Data were collected prospectively on 122 CABG patients, operated by a surgical team from March 2008 to August 2013. Patients were stratified into two groups: group 1 received DAPT within 5 days of CABG (n=65), and group 2 where DAPT was discontinued for more than 5 days prior to CABG (n=57). All patients were diagnosed with acute coronary syndrome preoperatively, and all of them had haemoglobin levels above 110 g/L. Patients who needed reoperation, combined procedures, or off-pump revascularization were excluded. Results: There was no hospital mortality. Mean chest tube losses after the surgical revascularization did not differ significantly, but group 1 received a higher quantity of transfused red blood cells and platelets. Conclusion: Urgent and emergent surgical revascularization using extracorporeal circulation in patients with acute coronary syndrome whose preoperative haemoglobin levels are above 110 g/L is a safe and effective procedure. We suggest that, where indicative, one may perform CABG in less than 5 days after the clopidogrel discontinuation. |
| first_indexed | 2024-12-12T11:00:08Z |
| format | Article |
| id | doaj.art-fe75a5f301594871a78952d1b2423eba |
| institution | Directory Open Access Journal |
| issn | 1678-9741 |
| language | English |
| last_indexed | 2024-12-12T11:00:08Z |
| publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
| record_format | Article |
| series | Brazilian Journal of Cardiovascular Surgery |
| spelling | doaj.art-fe75a5f301594871a78952d1b2423eba2022-12-22T00:26:34ZengSociedade Brasileira de Cirurgia CardiovascularBrazilian Journal of Cardiovascular Surgery1678-9741331596310.21470/1678-9741-2017-0083S0102-76382018000100059Postoperative Bleeding Following Preoperative Clopidogrel Administration in Patients with Haemoglobin Level Above 110 g/L Undergoing Urgent CABGSasa Milan KacarAleksandar MikicMirjana Božidar KačarAbstract Introduction: Patients with acute coronary syndrome usually receive dual antiplatelet therapy (DAPT) (usually clopidogrel + aspirin) prior to coronary catheterization, and approximately 10% of these patients require coronary artery bypass grafting (CABG). DAPT has favorable effects on prevention of thrombus formation, but it can have deleterious effects on surgical hemostasis. Anaemia, if present, gives additional risk to such patients. The aim of this study was to examine if DAPT affects postoperative bleeding in patients with haemoglobin levels above 110 g/L, who underwent urgent or emergent CABG, less than five days after stopping DAPT therapy. Methods: Data were collected prospectively on 122 CABG patients, operated by a surgical team from March 2008 to August 2013. Patients were stratified into two groups: group 1 received DAPT within 5 days of CABG (n=65), and group 2 where DAPT was discontinued for more than 5 days prior to CABG (n=57). All patients were diagnosed with acute coronary syndrome preoperatively, and all of them had haemoglobin levels above 110 g/L. Patients who needed reoperation, combined procedures, or off-pump revascularization were excluded. Results: There was no hospital mortality. Mean chest tube losses after the surgical revascularization did not differ significantly, but group 1 received a higher quantity of transfused red blood cells and platelets. Conclusion: Urgent and emergent surgical revascularization using extracorporeal circulation in patients with acute coronary syndrome whose preoperative haemoglobin levels are above 110 g/L is a safe and effective procedure. We suggest that, where indicative, one may perform CABG in less than 5 days after the clopidogrel discontinuation.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382018000100059&lng=en&tlng=enAcute coronary syndromeHemorrhage/prevention & controlCoronary artery bypassPlatelet aggregation inhibitorsBlood plateletsTreatment outcomeMortalityMorbiditySurvival |
| spellingShingle | Sasa Milan Kacar Aleksandar Mikic Mirjana Božidar Kačar Postoperative Bleeding Following Preoperative Clopidogrel Administration in Patients with Haemoglobin Level Above 110 g/L Undergoing Urgent CABG Brazilian Journal of Cardiovascular Surgery Acute coronary syndrome Hemorrhage/prevention & control Coronary artery bypass Platelet aggregation inhibitors Blood platelets Treatment outcome Mortality Morbidity Survival |
| title | Postoperative Bleeding Following Preoperative Clopidogrel Administration in Patients with Haemoglobin Level Above 110 g/L Undergoing Urgent CABG |
| title_full | Postoperative Bleeding Following Preoperative Clopidogrel Administration in Patients with Haemoglobin Level Above 110 g/L Undergoing Urgent CABG |
| title_fullStr | Postoperative Bleeding Following Preoperative Clopidogrel Administration in Patients with Haemoglobin Level Above 110 g/L Undergoing Urgent CABG |
| title_full_unstemmed | Postoperative Bleeding Following Preoperative Clopidogrel Administration in Patients with Haemoglobin Level Above 110 g/L Undergoing Urgent CABG |
| title_short | Postoperative Bleeding Following Preoperative Clopidogrel Administration in Patients with Haemoglobin Level Above 110 g/L Undergoing Urgent CABG |
| title_sort | postoperative bleeding following preoperative clopidogrel administration in patients with haemoglobin level above 110 g l undergoing urgent cabg |
| topic | Acute coronary syndrome Hemorrhage/prevention & control Coronary artery bypass Platelet aggregation inhibitors Blood platelets Treatment outcome Mortality Morbidity Survival |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382018000100059&lng=en&tlng=en |
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