Frequency of Deep Vein Thrombosis and/or Pulmonary Embolism After Coronary Artery Bypass Grafting Investigation Regardless of Clinical Suspicion

Viana, Vitor Borges; Melo, E.; Terra-Filho, Mário; Dallan, Luís Alberto Oliveira; Gonzalez, Maria Margarita; Hajjar, Ludhmila Abrahão; Jatene, Fábio Biscegli; Cesar, Luiz Antônio Machado; Vianna, Caio Brito

doi:10.1016/j.amjcard.2016.09.056

Cited by 15 publications

(8 citation statements)

References 22 publications

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“…This then causes damage to endothelial factors of the lungs, leading to formation of thrombi. 40 Therefore, to effectively reduce the occurrence of APE, surgeons need to reduce the operation time as much as possible.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for acute pulmonary embolism in patients with off-pump coronary artery bypass grafting: implications for nursing

Zhou

Cao

et al. 2020

J Int Med Res

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Objective Acute pulmonary embolism (APE) is a serious complication after off-pump coronary artery bypass grafting (OPCABG). We aimed to analyze the risk factors for APE in patients with OPCABG. Methods In this retrospective, observational study, patients with OPCABG who were treated in our hospital from 1 January 2018 to 31 March 2020 were included. The basic characteristics of patients and results of preoperative laboratory examinations were collected and analyzed. Results A total of 707 patients with OPCABG were included and the incidence of APE was 3.21%. Left ventricular ejection fraction (LVEF), a history of smoking, number of bypass grafting, duration of surgery, and age were significant risk factors for APE in patients with OPCABG. The areas under the curves of LVEF, number of bypass grafting, duration of surgery, and age were 0.773, 0.759, 0.738, and 0.723, respectively. The cutoff values of LVEF, number of bypass grafting, duration of surgery, and age were 59.84, 3.18, 237.42, and 73.28, respectively. Conclusions LVEF, a history of smoking, number of bypass grafting, duration of surgery, and age may be risk factors for APE in patients with OPCABG. Early measures should be taken to target these risks to prevent APE.

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Section: Discussionmentioning

confidence: 99%

Risk factors for acute pulmonary embolism in patients with off-pump coronary artery bypass grafting: implications for nursing

Zhou

Cao

et al. 2020

J Int Med Res

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show abstract

“…PE was diagnosed in 13% of the patients, DVT in 4% and both PE and DVT in 8% of them, for a total VTE incidence of 25%. Notably, a significant number of patients was asymptomatic and would have been discharged from the hospital without further treatment (10). A point to be considered concerns the fact that DVT may not be clinically significant in all patients, considering that most of the patients submitted to cardiac surgery are postoperatively treated with antiplatelet or anticoagulant drugs, which may contribute to a reduction of the clinical impact of VTE.…”

Section: Editorialmentioning

confidence: 99%

Venous thromboembolism prophylaxis after minimally-invasive cardiac surgery: harm or benefit?

Carretta

Lapenna

2020

J Thorac Dis

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“…Pulmonary embolism has been described in older studies in 1-9.5% after bypass operations [4,7]. More recent studies suggest that a higher incidence may be expected in clinically inconspicuous patients without anticoagulation (10.1-25%) [8][9][10]. Symptoms of embolism such as dyspnoea, thoracic pain, tachycardia, swelling of the legs, low oxygen saturation, or fever are usually associated with comorbidities or surgical trauma [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…More recent studies suggest that a higher incidence may be expected in clinically inconspicuous patients without anticoagulation (10.1-25%) [8][9][10]. Symptoms of embolism such as dyspnoea, thoracic pain, tachycardia, swelling of the legs, low oxygen saturation, or fever are usually associated with comorbidities or surgical trauma [10][11][12]. According to the German guideline (S3-AWMF), anticoagulation with unfractionated or low molecular weight heparin is recommended, resulting in significantly reduced incidences of thromboembolic events [13].…”

Section: Introductionmentioning

confidence: 99%

Bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative setting

Klingele

Enkel

Speer

et al. 2020

J Cardiothorac Surg

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Objectives: After elective cardiac surgery a postoperative anticoagulation is obligatory. With critically ill patients the conventional anticoagulation standard heparin is sometimes impossible, e.g. based on HIT II. Then, argatroban is currently a possible alternative, however, due to its impaired metabolism in critically ill patients, anticoagulation effect is harder to anticipate, thus resulting in higher bleeding risk. Furthermore, to date no antidote is available. Hence, severe postoperative bleeding incidents under anticoagulation are commonly mono-causal attributed to the anticoagulation itself. This study concentrates on the number of well-defined postoperative bleeding incidents before any anticoagulation started, then actually under argatroban as well as compared to those under heparin (or switched from heparin to argatroban). Material and methods: Retrospective study including 215 patients undergoing elective cardiac surgery with a postoperative stay in ICU ≥48 h. Postoperative bleeding complications before and after start of anticoagulation were evaluated. Definition of bleeding complications were: decrease of hemoglobin by more than 2 g/dl without dilution (mean value of volume balance plus one standard deviation) and/or increased need of red blood cell transfusion/day (average transfusion rate + 2 standard deviations). Results: Within the study group of 215 patients, 143 were treated with heparin, 43 with argatroban, 29 switched from heparin to argatroban. Overall, 26.5% (57/215) postoperative bleeding complications occurred. In 54.4% (31/57) bleeding complications occurred before start of anticoagulation; in 43.6% (26/57) after. Of these, 14 bleeding incidents occurred under heparin 9.8% (14/143), 6 under argatroban 14% (6/43) and 6 switched 20.7% (6/29). Higher bleeding complications before start of anticoagulation was related to concomitant factors influencing the overall bleeding risk; e.g. score of severity of illness. These observations further correlate with postoperative, but not anticoagulation induced mortality rate of 2.8% of then given heparin, 20.9% then argatroban, 20.7% then switched. Conclusions: Postoperative bleeding complications cannot simply be attributed to anticoagulation since occurring often before anticoagulation was started. The risk for bleeding complications after start of anticoagulation was quite comparable for argatroban and heparin. Accordingly, the influence of argatroban on bleeding complications in the postoperative period may be less significant than previously thought.

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Frequency of Deep Vein Thrombosis and/or Pulmonary Embolism After Coronary Artery Bypass Grafting Investigation Regardless of Clinical Suspicion

Cited by 15 publications

References 22 publications

Risk factors for acute pulmonary embolism in patients with off-pump coronary artery bypass grafting: implications for nursing

Risk factors for acute pulmonary embolism in patients with off-pump coronary artery bypass grafting: implications for nursing

Venous thromboembolism prophylaxis after minimally-invasive cardiac surgery: harm or benefit?

Bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative setting

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