Practice Considerations of Early Aspirin Administration following Coronary Artery Bypass Surgery

2011 ◽  
Vol 14 (1) ◽  
pp. 7 ◽  
Author(s):  
Philemon Gukop ◽  
Nicholaos Kakouros ◽  
Morteza Tavakkoli Hosseini ◽  
Oswaldo Valencia ◽  
Antonios Kourliouros ◽  
...  

Thrombotic occlusion of saphenous vein grafts (SVG), the conduits most commonly used in coronary artery bypass grafting (CABG) surgery, causes significant morbidity and mortality. There is class 1A evidence that early aspirin administration following CABG reduces thrombotic SVG occlusion, as well as overall morbidity and mortality. The American Heart Association/American College of Cardiology and the European Association of Cardiothoracic Surgeons have issued guidelines recommending that 150 to 325 mg aspirin be administered within 6 hours following CABG. We carried out a clinical audit of our practice to identify any reasons for deviation from these standards of care and to implement any corrective measures. We prospectively collected data on 200 consecutive patients who underwent CABG to assess both the compliance in prescribing and administering aspirin and the effect on blood loss and transfusion requirements. Sixty-nine percent of patients received an aspirin loading dose 6 hours postoperatively. The reasons for nonadministration of aspirin were postoperative bleeding (10%), lack of a prescription despite aspirin being clinically indicated (13%), and a prescription for aspirin but no administration (9%). Reasons included inadequate handover between clinical teams (4%), aspirin loading 24 hours preoperatively (2%), and administration after the first 6 hours (3%). Our audit showed that early aspirin administration did not cause further bleeding or increase blood or blood product transfusion. We followed the recommendations in the majority of cases, but there is scope for improvement in this practice and a need to address "gray areas" not covered by the guidelines.

2009 ◽  
Vol 17 (4) ◽  
pp. 368-372 ◽  
Author(s):  
Joanna Ooi Su Min ◽  
Abdul Rahman Mohd Ramzisham ◽  
Mohd Dimon Zamrin

The aim of this study was to compare 6% hydroxyethyl starch 130/0.4 with 4% succinylated gelatin for priming the cardiopulmonary bypass circuit and as volume replacement in patients undergoing coronary artery bypass, in terms of postoperative bleeding, blood transfusion requirements, renal function, and outcome after surgery. Forty-five patients received 6% hydroxyethyl starch 130/0.4 (Voluven) and another 45 were given 4% succinylated gelatin (Gelofusine) as the priming solution for the cardiopulmonary bypass circuit as well as for volume replacement. Postoperative bleeding was quantified from the hourly chest drainage in the first 4 h and at 24 h postoperatively. The baseline characteristics of both groups were similar. In the hydroxyethyl starch group, the total amount of colloid used was 1.9 ± 1.0 L, while the gelatin group had 2.0 ± 0.7 L. There was no significant difference in hourly chest drainage between groups. Blood transfusion requirements, estimated glomerular filtration rate, extubation time, intensive care unit and hospital stay were similar in both groups. It was concluded that 6% hydroxyethyl starch 130/0.4 is a safe alternative colloid for priming the cardiopulmonary bypass circuit and volume replacement in patients undergoing coronary artery bypass surgery.


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