scholarly journals Investigation of the Effect of Protamine-heparin Dose Ratio Adjustment on Intraoperative Graft Patency and Postoperative Bleeding

2021 ◽  
Vol 6 (4) ◽  
pp. 444-450
Author(s):  
Ferhat Borulu
Keyword(s):  
Postoperative Bleeding ◽  
Graft Patency ◽  
Dose Ratio ◽  
Heparin Dose

The Effect of Combined Clopidogrel and Aspirin Therapy after Off-Pump Coronary Surgery

2009 ◽  
Vol 4 (5) ◽  
pp. 265-268 ◽  
Author(s):  
Emir Mujanovic ◽  
Midhat Nurkic ◽  
Jasmin Caluk ◽  
Ibrahim Terzic ◽  
Emir Kabil ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Median Sternotomy ◽  
Operation Time ◽  
Graft Patency ◽  
Off Pump ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. Methods Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. Results Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. Conclusions Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting.

Abstract 2051: Recombinant Factor VIIa Affects Vein Graft Patency and Flow in Rabbits

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
David Mazer ◽  
Howard Leong-Poi ◽  
Zuhair Alfardan ◽  
Zhilan Wang ◽  
Beiping Qiang ◽  
...  
Keyword(s):  
Recombinant Factor Viia ◽  
Factor Viia ◽  
Postoperative Bleeding ◽  
Rabbit Model ◽  
Graft Patency ◽  
Vessel Diameter ◽  
Factor Vii ◽  
Activity Levels ◽  
Graft Occlusion ◽  
Plasma Factor

INTRODUCTION: Recombinant factor VIIa (rVIIa) has been used to decrease postoperative bleeding in cardiac surgical patients. However, there is potential for rVIIa to interact with tissue factor expression at the site of new anastomoses resulting in early graft occlusion. This safety study tested the hypothesis that the administration of rVIIa dose-dependently reduces graft patency at the site of new vascular anastomoses comparable in size to human coronaries, in a rabbit model. METHODS: After ACC approval, a reversed venous graft was fashioned in the right carotid artery using autologous right jugular vein with 9 – 0 sutures in 64 anesthetized and heparinized rabbits. Animals were then given either one of three doses of rVIIa (300 ug/kg, 90 ug/kg or 20 ug/kg IV) or placebo (n=16/group). The primary outcome was graft patency, measured by a blinded observer 24 hours postoperatively using vascular ultrasound (HDI 5000cv, 15 MHz probe) and/or direct inspection. Factor VII activity levels were measured from citrated plasma samples with a 1-stage prothrombin time-based assay using rabbit thromboplastin. Data was analyzed using chi-square, fishers exact test, or ANOVA where appropriate, with p<0.05 considered significant. RESULTS: Physiologic variables (ACT, hemoglobin, pH, pCO2) and vessel diameter were similar between groups. Graft patency and flow were significantly reduced, and plasma factor VII levels significantly increased in the rVIIa treated rabbits in a dose-dependent fashion. DISCUSSION: The study suggests that high doses of rVIIa (300 and 90 ug/kg) are associated with an increased incidence of occlusion of new vascular grafts. A clear dose-response effect was observed, suggesting that higher doses may be associated with increased thrombotic outcomes.

Heparin Dose, Transfusion Rates, and Intraoperative Graft Patency in Minimally Invasive Direct Coronary Artery Bypass

2005 ◽  
Vol 6 (3) ◽  
pp. 176 ◽  
Author(s):  
Harry W. Donias ◽  
Giuseppe D'Ancona ◽  
Ravi U. Pande ◽  
Dennis Schimpf ◽  
Akira T. Kawaguchi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Graft Patency ◽  
Heparin Dose

Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 474-481 ◽  
Author(s):  
Radak ◽  
Babic ◽  
Ilijevski ◽  
Jocic ◽  
Aleksic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Iliac Artery ◽  
Graft Patency ◽  
Long Term Results ◽  
Surgical Reconstruction ◽  
Safe Procedure ◽  
Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

Nichtinvasive Beurteilung aortokoronarer Venenbrücken mit Kernspintomographie

1989 ◽  
Vol 28 (06) ◽  
pp. 234-242 ◽  
Author(s):  
U. Sechtem ◽  
Sabine Langkamp ◽  
M. Jungehülsing ◽  
H. H. Hilger ◽  
H. Schicha ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Coronary Artery Bypass ◽  
Spin Echo ◽  
Artery Bypass ◽  
Graft Patency ◽  
Coronary Artery Bypass Grafts ◽  
Resonance Imaging ◽  
Low Sensitivity

Fortyfour patients with recent cardiac catheterization because of recurrent chest pain after coronary artery bypass surgery were studied by magnetic resonance imaging to evaluate graft patency. To assess the efficacy of this non-invasive method 92 coronary artery bypass grafts were examined by the spin-echo technique. ECG-gated transversal sections were acquired between the diaphragm and the aortic arch. The specificity of magnetic resonance imaging was 83% (48/58) for patent grafts. However, the sensitivity in the detection of occluded bypasses was only 56% (19/34). Despite the good specificity, clinical applications of this method are limited because of its low sensitivity.

Effects on Coagulation and Fibrinolysis of Desmopressin in Patients Undergoing Total Hip Replacement

1991 ◽  
Vol 66 (06) ◽  
pp. 652-656 ◽  
Author(s):  
Per Anders Flordal ◽  
Karl-Gösta Ljungström ◽  
Jan Svensson ◽  
Brenda Ekman ◽  
Gustaf Neander
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Bleeding Time ◽  
Antithrombin Iii ◽  
Postoperative Bleeding ◽  
Double Blind ◽  
Total Hip ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
Coagulation And Fibrinolysis

SummaryTwelve patients undergoing total hip replacement, with regional anaesthesia and with dextran infusion for plasma expansion and thromboprophylaxis, were given the vasopressin analogue desmopressin (DDAVP) or placebo in a randomized, double-blind prospective study. In controls (n = 6) we found a prolongation of the bleeding time, low factor VIII (FVIII) and von Willebrand factor (vWF) and a decrease in antithrombin III to levels known to be at risk for venous thrombosis. Desmopressin shortened postoperative bleeding time, gave an early FVIII/vWF complex increase, prevented antithrombin III from falling to critically low values and appeared to activate the fibrinolytic system, both by tPA increase and PAI-1 decrease.Thus in the controls we found changes in both coagulation and fibrinolysis indicating a haemorrhagic diathesis as well as a risk for thromboembolism. Desmopressin induced factor changes that possibly reduce both risks.

Oral Anticoagulation in the Prevention of One-Year Vein Graft Occlusion after Aortocoronary Bypass Surgery: Optimal Therapeutic Range and Practical Limitations

1994 ◽  
Vol 72 (05) ◽  
pp. 676-681 ◽  
Author(s):  
J van der Meer ◽  
H L Hillege ◽  
P H J M Dunselman ◽  
B J M Mulder ◽  
H R Michels ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Major Bleeding ◽  
Oral Anticoagulation ◽  
Vein Graft ◽  
Oral Anticoagulant Therapy ◽  
Coronary Bypass ◽  
Graft Patency ◽  
Graft Occlusion ◽  
Coronary Bypass Grafts ◽  
One Year

SummaryTo assess the optimal level of oral anticoagulation to prevent occlusion of vein coronary bypass grafts, 318 patients from a graft patency trial were analysed retrospectively. Oral anticoagulant therapy was started one day before surgery and continued for one year, after which graft occlusion was assessed by angiography. The aimed level of anticoagulation was 2.8-1.8 International Normalized Ratio (INR). Clinical outcome was assessed by the incidence of myocardial infarction, thrombosis and major bleeding.The observed anticoagulation level was 2.8-4.8 INR for 54%, and 1.8-3.8 INR for 75% of time per patient. Occlusion rates in patients who spent <35, 35-70, and ≥70% of time within INR range 2.8-1.8 were 10.5%, 10.8% and 11.8%, respectively (differences not statistically significant). Patients who spent ≥70% of time within INR range 1.8-3.8 versus 2.8-4.8 showed comparable occlusion rates. The risk of graft occlusion was not related to quality of anticoagulation early (0-3 months) or late (3-12 months) after surgery. Myocardial infarction, thrombosis and major bleeding occurred in 1.3%, 2.0% and 2.9% of patients.To maintain vein graft patency in the first postoperative year by oral anticoagulation, a level within INR range 1.8-3.8 for ≥70% of time seems to be sufficient.

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