Comparison of Outcome of Bleeding with Single and Dual Antiplatelet Therapy in Beating Heart Surgery

2021 ◽  
Vol 15 (8) ◽  
pp. 2123-2126
Author(s):  
Waseem Rehman ◽  
Aqeel Ahmed ◽  
Husnain Bashir ◽  
Ubaid Ullah ◽  
Muhammad Mohsin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Heart Surgery ◽  
Dual Antiplatelet Therapy ◽  
Beating Heart ◽  
Blood Products ◽  
Beating Heart Surgery ◽  
Perioperative Bleeding ◽  
Group A ◽  
Group B

Objective: To compare the outcome of Bleeding with Single and Dual Antiplatelet Therapy in Beating Heart Surgery Methodology: A total of 102 cases between 25 to 60 years, of either gender, advised CABG procedure and suitable for beating heart surgery were included in the study. Whereas those with known bleeding diathesis, not suitable candidate for beating heart surgery and with concomitant valvular heart disease were excluded from the study. These cases were enrolled through wards of Cardiothoracic Surgery Department, Shaikh Zayed Hospital, Lahore. Three groups were formed A,B and C. Group-A was assigned to DAPT, Group-B was SAPT (single anti platelet therapy) and Group ”C” was on DAPT that is ASPRIN 75 mg and CLOPIDOGREL 75mg till the time of surgery. Control group A was compared with group B (SAPT) and group C (DAPT) for bleeding risk. The indications of blood products transfusion was assessed by baseline HCT platelet counts, PT and APTT. The CABG was carried out through a full sternotomy incision, under general anesthesia by using routine cardio protective measures and surgical techniques. Operating surgeon decided for on pump or off pump CABG. All patients were assessed and managed in ICU after Coronary artery bypass grafting. Duty doctor and anesthetist decided about transfusion of any allogenic blood product. Transfusion decision was made on the basis of routine laboratory values of APTT, ACT, and INR of PT, as well as on Hb. and HCT levels. Moreover, the need of non-self blood products was predicted. Results: In our study, mean age was calculated as 52.65+7.48 years, 50.32+5.68 years and 48.47+5.96 years respectively, 61.76%(n=21) in Group-A, 52.94%(n=18) in Group-B and 44.12%(n=15) in Group-C were male whereas 38.24%(n=13) in Group-A, 38.24%(n=16) in Group-B and 55.88%(n=19) in Group-C were females, comparison of Perioperative blood loss as 597.29+129.26 in Group-A, 643.18+65.42 in Group-B and 654.70+59.16 in Group-C, p value was 0.02. Conclusion: We concluded that Dual Antiplatelet Therapy have more chances of Peri-Operative bleeding as compare to heparin only or Single Antiplatelet Therapy in Coronary artery bypasses grafting on Beating heart. However, it has advantage of short pre procedure stay, reduced chances of ischemic events, less chance of canula related cellulitis and less chances of HIT. Whereas the cases administered with Heparin alone are having a greater chance of canula related cellulitis, expensive, prolonged pre procedure hospital stay with increased chances of HIT (Heparin induced thrombocytopenia. Keywords: CABG , Perioperative bleeding, Dual Antiplatelet Therapy, Single Antiplatelet Therapy

On-Pump Beating Heart Surgery Offers an Alternative for Unstable Patients Undergoing Coronary Artery Bypass Grafting

2005 ◽  
Vol 7 (2) ◽  
pp. 88 ◽  
Author(s):  
James R. Edgerton ◽  
Morley A. Herbert ◽  
Katherine K. Jones ◽  
Syma L. Prince ◽  
Tea Acuff ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Beating Heart ◽  
Bypass Grafting ◽  
Beating Heart Surgery ◽  
Artery Bypass Grafting

Effects of Edoxaban on the Cellular and Protein Phase of Coagulation in Patients with Coronary Artery Disease on Dual Antiplatelet Therapy with Aspirin and Clopidogrel: Results of the EDOX-APT Study

2019 ◽  
Vol 120 (01) ◽  
pp. 083-093 ◽  
Author(s):  
Francesco Franchi ◽  
Fabiana Rollini ◽  
Emilio Garcia ◽  
Jose Rivas Rios ◽  
Andrea Rivas ◽  
...  
Keyword(s):  
Phase I ◽  
Antiplatelet Therapy ◽  
Phase Ii ◽  
Low Dose ◽  
Dual Antiplatelet Therapy ◽  
High Dose ◽  
Once Daily ◽  
Daily Group ◽  
Group A ◽  
Group B

AbstractIn patients requiring dual antiplatelet therapy (DAPT) who also have an indication to be treated with oral anticoagulant (OAC) drugs, aspirin withdrawal reduces the risk of bleeding. There is limited data on the pharmacodynamic effects associated with adding a nonvitamin K antagonist OAC on a background of aspirin and a P2Y12 inhibitor as well as dropping aspirin. Seventy-five patients on DAPT (aspirin plus clopidogrel) were randomized to DAPT plus high-dose edoxaban (60 mg once daily, Group A), DAPT plus low-dose edoxaban (30 mg once daily, Group B), or DAPT only (Group C) for 10 ± 2 days (Phase I). Afterwards, Groups A and B interrupted aspirin and maintained clopidogrel plus edoxaban for 10 ± 2 days, while patients in Group C maintained DAPT (Phase II). Platelet aggregation and clot kinetics were assessed at baseline, end of Phase I, and end of Phase II using thrombelastography (TEG), light transmittance aggregometry (LTA), VerifyNow P2Y12, and serum thromboxane-B2. The primary endpoint was the comparison of maximum amplitude (MA) measured by TEG, a measure of clot strength, between patients on DAPT plus high-dose edoxaban and patients on DAPT only. Edoxaban prolonged in a dose-dependent manner speed of thrombin generation (TEG R; Group A: 7.7 [6.8–8.7] vs. Group B: 7.4 [6.4–8.5] vs. Group C: 6.3 [5.7–7.0]; p = 0.05) but did not affect other markers of clot kinetics, including TEG MA (Group A: 63 [61–64] vs. Group B: 65 [63–67] vs. Group C: 64 [63–65]; p = 0.10). After aspirin discontinuation, platelet reactivity assessed by LTA using thrombin receptor activating peptide as agonist increased to a greater extent with low-dose edoxaban. Stopping aspirin did not affect markers of P2Y12 reactivity and had no or marginal effects on clot kinetics, but increased markers sensitive to cyclooxygenase-1 blockade.

Does Dual Antiplatelet Therapy Affect Blood Loss and Transfusion Requirements in Robotic-Assisted Coronary Artery Surgery?

2012 ◽  
Vol 7 (6) ◽  
pp. 399-402 ◽  
Author(s):  
Jonathan M. Hemli ◽  
Lincoln S. Darla ◽  
Christopher R. Panetta ◽  
Joan Jennings ◽  
Valavanur A. Subramanian ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Antiplatelet Agents ◽  
Coronary Surgery ◽  
Robotic Assisted ◽  
Coronary Syndrome ◽  
Perioperative Bleeding ◽  
Transfusion Requirements ◽  
The Impact

Objective Patients who present for coronary surgery often receive preoperative dual antiplatelet therapy with aspirin and a thienopyridine derivative (clopidogrel or prasugrel), especially after a recent acute coronary syndrome. Studies have shown that patients on aspirin and clopidogrel are at increased risk for perioperative bleeding and related events. We sought to examine the impact of dual antiplatelet therapy on bleeding and transfusion requirements in patients undergoing robotic-assisted minimally invasive coronary artery bypass grafting. Methods From January 2010 to November 2011, a total of 110 patients underwent robotic-assisted off-pump coronary surgery at our institution. All patients underwent robotic-assisted harvest of the left internal mammary artery from the chest wall. Some patients then underwent direct coronary anastomosis to the left anterior descending coronary artery via a left minithoracotomy, whereas others had a complete robotic endoscopic procedure within the closed chest. The patients were divided into two groups for outcome analysis on the basis of preoperative antiplatelet therapy: group 1 (either aspirin alone or no antiplatelet agents at all; n = 53) and group 2 (aspirin plus clopidogrel or prasugrel; n = 57). Results Perioperative chest tube drainage was not significantly different between the patient groups, irrespective of the preoperative antiplatelet agents used. Transfusion requirements and other morbidities were also similar in both groups of patients. Conclusions Preoperative dual antiplatelet therapy does not result in significantly increased bleeding or perioperative transfusion requirements. If clinically indicated, it is reasonable to continue preoperative combination antiplatelet therapy in patients undergoing robotic-assisted coronary surgery.

Abstract 14199: Long-term Impact of Baseline Anemia and Dual Antiplatelet Therapy Duration After Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Huntae Kim ◽  
Jong-Il Park ◽  
Byung-Jun Kim ◽  
Jung-hee Lee ◽  
Ung Kim ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Target Vessel Revascularization ◽  
Percutaneous Coronary ◽  
Group A ◽  
Group B ◽  
Group D

Background: Anemia is a known risk factor for future ischemic events and bleeding for patients with ischemic heart disease. However, there are little data about dual antiplatelet therapy (DAPT) duration for patients with anemia after percutaneous coronary intervention (PCI). Methods: From 2010 to 2013, a total of 1,470 patients who underwent PCI were investigated. We categorized the study population into four groups based on the DAPT duration and anemia (Hemoglobin <13g/dL for men and <12g/dL for women): Group A (non-anemia & ≤12m DAPT, n=521), Group B (non-anemia & >12m DAPT, n=501), Group C (anemia & ≤12m DAPT, n=226), and Group D (anemia & >12m DAPT, n=222). We evaluated major adverse cardiovascular and cerebrovascular events (MACCEs), defined as cardiac death, myocardial infarction, repeat target vessel revascularization, or stroke, and bleeding complication. Results: Even though anemic patients had more severe angiographic findings, such as three-vessel disease or diffuse long lesion, the DAPT duration was similar between anemia and non-anemia group. MACCEs occurred less frequently in Group B (16.9%) than Group A (24.7%), Group C (34.6%), and Group D (35.1%) (p<0.001) at 8 years. After multivariate analysis, with Group A as a reference, the adjusted hazard ratio for MACCEs was 0.711 (95% confidence interval [CI] 0.526-0.961, p=0.027) for Group B, 1.126 (95% CI 0.802-1.581, p=0.494) for Group C, and 0.995 (95% CI 0.706-1.405, p=0.980) for Group D. However, major bleeding occurred more frequently occurred in Group D (13.0%) than Group A (5.7%), Group B (7.5%), and Group C (11.2%) (p=0.035) at 8 years. Conclusions: Although extended DAPT showed reduced rate of MACCEs for non-anemic patients, it can be related with increased of major bleeding for anemic patients.

Abstract WMP33: Peri-operative Dual Antiplatelet Therapy for the Coil Embolization of Unruptured Brain Aneurysms: The Efficacy and the Side Effect

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kenichi Sakuta ◽  
Ichiro Yuki ◽  
Toshihiro Ishibashi ◽  
Shogo Kaku ◽  
Yuichi Sasaki ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Coil Embolization ◽  
Side Effect ◽  
Thromboembolic Event ◽  
Dual Antiplatelet Therapy ◽  
Statistical Significance ◽  
Hemorrhagic Complication ◽  
Brain Aneurysm ◽  
Group A ◽  
Group B

Backgrounds: Optimal dose and duration of antiplatelet therapy before / after the coil embolization of unruptured aneurysm has not been established, yet. The dual antiplatelet therapy (DAPT) using aspirin and clopidogrel started 3 to 7 days before operation has been a commonly used antiplatelet protocol, although few studies have done to evaluate the relationship between the duration of the pre-operative DAPT and its efficacy / side effects. In the present study, the different durations of the pre-operative DAPT and their related “efficacy / side effect” was retrospectively analyzed. Method: A total of 232 unruptured brain aneurysm patients (male, n=62; median age, 61 y) who underwent coil embolization were enrolled in this study. Fifty-two (22%) patients underwent stent assisted coil embolization. The patients were categorized into 3 different groups depending on the duration of the DAPT: Group A (within 3days), Group B (4-6 days) and Group C (7 days or longer). The platelet aggregation profiles are evaluated on the day of procedure. Post-operative MRI, the neurological findings and the peri-operative hemorrhagic events between the 3 groups were compared. Results: Diffusion weighted image (DWI) performed the day after the operation showed that 169 (73%) patients had any high intensity lesion in the ipsilateral perfusion area of the treated artery, and 8 (3%) represented symptomatic infarction. The both adenosine diphosphate (ADP) and collagen aggregation were significantly decreased in the group of longest DAPT period (vs Group A (ADP; 45% vs 15%, P <0001, collagen 99% vs 90% P =0.008), vs Group B (ADP; 45% vs 27%, P =0.032, collagen 99% vs 94%, P =0.137)). The symptomatic infarction after operation tended to decrease with longer DAPT period without statistical significance. The rate of hemorrhagic complication was not increased by the longer DAPT period during the observation period. Conclusion: Longer DAPT period significantly reduced both the ADP and collagen aggregation. The rate of symptomatic thromboembolic event tended to decrease with longer DAPT period without statistical significance. With increased number of patient, longer DAPT protocol may reduce the thromboembolic event without increasing the hemorrhagic complication rate.

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