Impact of Thrombocytopenia on Postoperative Bleeding Incidence in Patients Receiving Aspirin Following Coronary Artery Bypass Grafting

2020 ◽  
pp. 089719002096619
Author(s):  
Anne M. Rodino ◽  
James B. Henderson ◽  
Kelsey F. Dobbins ◽  
Deanna T. Rubin ◽  
Ian B. Hollis
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Major Bleeding ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Postoperative Bleeding ◽  
Bleeding Risk ◽  
Cabg Surgery ◽  
Significant Difference ◽  
The Impact

Background: Early postoperative aspirin following coronary artery bypass graft (CABG) surgery has been shown to maintain bypass graft patency, reduce mortality, and prevent adverse cardiovascular events. Despite this known benefit, aspirin may be delayed due to thrombocytopenia and perceived higher bleeding risk. The purpose of this study was to assess the impact of postoperative platelet count on bleeding in patients receiving aspirin after CABG. Methods: A retrospective analysis included all patients who underwent CABG surgery at our institution from April 2014 to June 2018 and received aspirin within 24 hours. The primary outcome was International Society on Thrombosis and Hemostasis (ISTH) major bleeding within 7 days (or up to discharge) following CABG surgery compared between patients with and without postoperative thrombocytopenia. Results: This study included 280 patients. Major bleeding occurred in 24.6% of the population, with no difference when stratified by the presence or absence of postoperative thrombocytopenia (27.3% versus 23.8%, p = 0.571). There was no significant difference in hemoglobin fall (13.6% versus 14%, p = 0.948), transfusion requirement (6.1% versus 4.2%, p = 0.531), or critical site bleeding (12.1% versus 7.9%, p = 0.298). Conclusion: In this single-center analysis of patients who received aspirin within 24 hours of CABG, postoperative thrombocytopenia was not associated with an increase in bleeding.

scholarly journals Aprotinin Decreases Postoperative Bleeding and Number of Transfusions in Patients on Clopidogrel Undergoing Coronary Artery Bypass Graft Surgery

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Jan van der Linden ◽  
Gabriella Lindvall ◽  
Ulrik Sartipy
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Unstable Angina ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Postoperative Bleeding ◽  
Artery Bypass Graft ◽  
Perioperative Bleeding ◽  
The Impact

Background— Clopidogrel, an irreversible platelet inhibitor, is used to treat patients with unstable angina. These patients often present for coronary artery bypass graft surgery (CABG) and are at increased risk for perioperative bleeding. The current investigation evaluates the impact of aprotinin on bleeding and transfusion requirements in clopidogrel-treated patients undergoing CABG. Methods and Results— Seventy-five consecutive patients with unstable angina, administered clopidogrel <5 days before CABG, were randomized. Using a double-blind design, patients received full-dose aprotinin (n =37) or saline (n =38). Elapsed times between the last dose of clopidogrel and start of the operation were similar between the 2 groups [aprotinin, 58±28 hour (mean± SD); control, 54±27 hour; P =0.86], as were age (aprotinin, 66.4±10 years; control, 68.3±10 years; P =0.51), number of distal anastomoses (aprotinin, 3.6±1.0; control, 3.7±1.0; P =0.79), operative times (aprotinin, 192±48 minutes; control, 200±53 minutes; P =0.55), and lowest intraoperative hemoglobin level (aprotinin, 87±14 g/L; control, 88±14 g/L; P =0.60). Postoperative bleeding was 760±350 mL in aprotinin-treated patients versus 1200±570 mL ( P <0.001) in control. During the hospital stay, patients in the aprotinin group received 1.2±1.5 and 0.1±0.4 U of erythrocytes and platelets, respectively, versus 2.8±3.2 ( P =0.02) and 0.9±1.4 ( P =0.002) units in the control. In the aprotinin group, 53% of patients received transfusions, whereas 79% of controls were exposed to blood products ( P =0.02). Conclusions— Intraoperative aprotinin decreases postoperative bleeding and the number of transfusions in patients undergoing CABG and treated with clopidogrel <5 days before surgery.

Predictiveness of different preoperative risk assessments for postoperative bleeding after coronary artery bypass grafting surgery

Perfusion ◽  
2020 ◽  
pp. 026765912094132
Author(s):  
Eren Gunertem ◽  
Salim Urcun ◽  
Arda Aybars Pala ◽  
Ali Baran Budak ◽  
Murat Abdulhamid Ercisli ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Postoperative Bleeding ◽  
Scoring Systems ◽  
Bleeding Risk ◽  
Risk Assessments ◽  
Artery Bypass Graft

Aim: Postoperative bleeding is a significant cause of morbidity and mortality in patients undergoing cardiac surgery. Studies have been conducted, and guidelines have been published regarding patient blood management and aiming to prevent blood loss in the perioperative period. Various bleeding risk assessments were developed for preoperative period. We aimed to examine the correlations of scoring systems in the literature with the amount of postoperative bleeding in patients undergoing first time coronary artery bypass graft surgery, and to show the most suitable preoperative bleeding risk assessment for coronary artery bypass graft patients. Methods: The study included 550 consecutive patients who underwent coronary artery bypass graft operation. The inclusion criteria were considered as patients to be older than 18 years old and to undergo elective or emergent myocardial revascularization using cardiopulmonary bypass. All variables required for scoring systems were recorded. The initial results of the study were determined as the amount of chest tube drainage, the use of blood products, the change in hematocrit level, reoperation due to bleeding, duration of ventilation, duration of intensive care unit stay, and hospital stay. Mortality which occurred during first 30 days after operation was considered as operative mortality. Operative mortality was accepted as the primary endpoint. Secondary endpoints were massive bleeding and high amount of transfusion. Results: Data were obtained from a series of 550 consecutive patients treated with isolated coronary artery bypass graft. It was seen that PAPWORTH and WILL-BLEED risk assessments responded better for E-CABG grade 2 and 3 bleeding compared to other risk assessments. TRACK, TRUST, and ACTA-PORT scales were found to have low ability to distinguish patients with E-CABG bleeding grade 2 and 3. Conclusion: Predicting postoperative bleeding and transfusion rates with preoperative risk scores in patients undergoing coronary artery bypass graft surgery will provide valuable information to physicians for establishing a proper patient blood management protocol and this will decrease excessive transfusions, unnecessary reoperations as well as improve postoperative outcomes.

scholarly journals Safety and Feasibility of Transradial Approach for Coronary Artery Bypass Graft Intervention

2020 ◽  
Vol 9 (1-2) ◽  
pp. 23-28
Author(s):  
Hemanta I Gomes ◽  
CM Shaheen Kabir ◽  
Saidur Rahman Khan ◽  
MG Azam ◽  
Syed Mosfiqur Rahman
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Clinical Characteristics ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Study Groups ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Significant Difference

  Background & Objective: To compare the safety and feasibility of using radial versus femoral access during coronary artery intervention of patients who had previously undergone coronary artery bypass graft (CABG) surgery. Methods: The study was conducted in Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka from January 2013 to December 2015. During the period a total of 380 patients with past CABG surgery underwent diagnostic coronary angiogram (CAG) and percutaneous coronary intervention (PCI) at our institution. We retrospectively evaluated 98 consecutive patients who underwent graft intervention via the transradial (TRA, n=54) or transfemoral approach (TFA, n=44) route. Baseline clinical characteristics, angiographic characteristics and complications between the two study groups were observed. Result: The baseline clinical characteristics between the two study groups were similar. No significant difference was observed in terms of angiographic characteristics between the two groups. Contrast volume in between the groups was pretty similar (p = 0.267). Procedure time (40±20 min vs. 41±7 min, p=0.36) and fluoroscopy time (11.1±6.5 min vs. 12.5±8.7 min, p=0.19) were almost similar in both access for graft intervention. All PCI attempts were successful in both groups. Stent deployment was significantly more common in the TR access group. No significant difference was observed between the groups in terms of target vessel intervention. There was no major adverse cardiac event during hospitalization. However, the vascular access site complications were significantly lower (p=0.003) in the TRA group. Conclusion: The TRA for coronary artery bypass graft intervention is safe and feasible. Ibrahim Card Med J 2019; 9 (1&2): 23-28

scholarly journals Acute Onset Ocular Hypotony after Coronary Artery Bypass Surgery

2017 ◽  
Vol 8 (1) ◽  
pp. 200-207
Author(s):  
Sarah Farukhi Ahmed ◽  
Audrey Xi Tai ◽  
Mason Schmutz ◽  
John Combs ◽  
Sameh Mosaed
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Vision Loss ◽  
Artery Bypass ◽  
Venous Pressure ◽  
Bypass Graft ◽  
Ischemic Optic Neuropathy ◽  
Cabg Surgery ◽  
Ocular Hypotony

Importance: The purpose of this case report is to evaluate risk factors associated with post-coronary artery bypass graft (CABG) ocular hypotony compared to post-CABG ischemic optic neuropathy. Observations: The patient described here is a single case at the University of California, Irvine Medical Center, from July 2016. This case demonstrates the rare incidence of acute post-CABG ocular hypotony and vision loss in a patient with prior history of optic atrophy. Both vision loss and hypotony resolved completely to baseline without intervention within 3 days postoperatively. Conclusions and Relevance: Severe anemia and large fluctuations in central venous pressure and blood pressure can occur in any patient undergoing CABG surgery. These hemodynamic shifts can cause transient ischemia to pressure controlling systems such as the ciliary body and reduce episcleral venous pressure. Other risk factors for acute hypotony in the setting of CABG surgery also include the use of hypertonic agents, cardiopulmonary bypass, and intravenous anesthesia.

IMMUNE FUNCTION IN THE EARLY POSTOPERATIVE PERIOD PREDICTS OUTCOME IN CORONARY ARTERY BYPASS GRAFT (CABG) SURGERY

1990 ◽  
Vol 18 (Supplement) ◽  
pp. S252
Author(s):  
Marcus P. Haw ◽  
Gregory T. Steltzer ◽  
Emma J. Lewis ◽  
Bradley C. Borlase ◽  
Lynda Kabbash ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Immune Function ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Early Postoperative Period ◽  
Artery Bypass Graft ◽  
Cabg Surgery

scholarly journals Outcome of off-pump coronary artery bypass graft (OPCAB) surgery: Analysis of 129 cases

2016 ◽  
Vol 31 (1) ◽  
pp. 23-25
Author(s):  
AKM Manzurul Alam ◽  
Istiaq Ahmed ◽  
Manzil Ahmed ◽  
Al Mamun Hossain
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Off Pump ◽  
Opcab Surgery ◽  
Pump Coronary Artery Bypass

Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, including Bangladesh. Besides medical and interventional treatment, coronary artery bypass graft (CABG) surgery in an effective modality for the management of a subset of CAD patients. Off-pump coronary artery bypass graft (OPCAB) surgery is a recent modification of conventional CABG surgery, which, like other parts of the world, is being increasingly practiced in Bangladesh. But the outcome of this relatively recent surgical approach in our setting is largely unknown. In this study, the outcomes of 129 cases off-pump CABG surgery done in a tertiary cardiovascular centre and a private institute in Dhaka were analyzed. Majority (67, 54.2%) had triple vessel disease (TVD), while 4 (3.2%) patients had left main disease. One, two and three grafts were used in 17 (13.2%),74 (57.4%) and 38 (29.4%) cases respectively. There was no mortality. Post-operative complications occurred in 17 (13.18%) patients; secondary wound infection in 10 (7.75%) and immediate respiratory distress in 7 (5.43%) cases. Ten (7.75%) patients needed secondary stitches.Bangladesh Heart Journal 2016; 31(1) : 23-25

Beating Heart Coronary Artery Bypass Grafting: A Theatre Nurse's Perspective

2000 ◽  
Vol 10 (3) ◽  
pp. 138-143
Author(s):  
Mark Spence
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Beating Heart ◽  
Artery Bypass Graft ◽  
Time Warp ◽  
Cabg Surgery ◽  
Technological Advances ◽  
High Level

Coronary artery bypass graft (CABG) surgery has been going through a time warp. The development of cardiopulmonary bypass (CPB), together with continuing advances in equipment and refinement of techniques, introduced a high level of safety for CABG operations. Recently, however, with pharmacological and technological advances, surgeons have been able to ‘go back in time’ and undertake complex CABG surgery without CPB.

Vitamin D Treatment Attenuates Heart Apoptosis After Coronary Artery Bypass Surgery: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial

2020 ◽  
Vol 25 (4) ◽  
pp. 338-345 ◽  
Author(s):  
Erfan Tasdighi ◽  
Manouchehr Hekmat ◽  
Mahmoud Beheshti ◽  
Ramin Baghaei ◽  
Seyed Mohsen Mirhosseini ◽  
...  
Keyword(s):  
Vitamin D ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Inflammatory Status ◽  
Significant Difference

Background: Vitamin D plays an important role in immune system and in the regulation of inflammatory cytokines. Coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) is associated with an extensive inflammatory response. The aim of this study is to examine the effect of vitamin D treatment on the apoptosis and inflammatory changes developed after CABG. Methods: This trial was conducted on 70 patients undergoing CABG with CPB. Patients were randomly administered either in placebo or in the group of orally consuming 150 000 IU vitamin D daily for 3 consecutive days before surgery. The right atrium sample was taken to assess caspases 2, 3, and 7 activity using immunohistochemistry method. The serum level of interleukin-10 (IL-10) and insulin-like growth factor 1 (IGF-1) were compared at intervals. Results: The average number of positive cells for caspases 2 and 3 were less in vitamin D group ( P = .006 and P < .001, respectively). There was an increase in serum levels of IL-10 after 3 days from vitamin D treatment before surgery (vitamin D group = 4.4 ± 4.9 ng/mL and control group = 1 ± 0.5 ng/mL, P = .001). After operation, IL-10 increased in both groups, higher level in vitamin D group ( P < .001). The comparison of serum IGF-1 showed significant difference after 3 days ( P = .006) and remained higher in vitamin D group after CPB ( P < .001). Conclusions: These findings suggest the apoptosis rate after CPB can be reduced by vitamin D. Vitamin D treatment may improve the inflammatory status before and after surgery. Further studies are needed to confirm the antiapoptotic property of vitamin D and clinical implication.

Sign in / Sign up

Export Citation Format

Share Document