Optimal Timing of Discontinuation of Clopidogrel and Risk of Blood Transfusion After Coronary Surgery  - Propensity Score Analysis -

Mariscalco, Giovanni; Bruno, Vito Domenico; Cottini, Marzia; Borsani, Paolo; Banach, Maciej; Piffaretti, Gabriele; Dominici, Carmelo; Beghi, Cesare; Sala, A.

doi:10.1253/circj.cj-11-0620

Cited by 12 publications

(11 citation statements)

References 34 publications

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“…Patients receiving four or more distal anastomoses did not show a higher incidence of blood transfusion compared to patients receiving three or less distal anastomoses. Moreover, while Karthik et al [25] described an increased risk for excessive bleeding with preoperative use of Acetylsalicylic acid, no significant association with greater transfusion rates was found in our population. In accordance to previous studies, where the use of ADP receptor inhibitors in addition to Acetylsalicylic acid has been an independent predictor of EC transfusions and re-operation for bleeding, active medical treatment with ADP receptor inhibitors was as associated with increased EC transfusion rates in our univariable analysis [26,27].…”

Section: Discussioncontrasting

confidence: 87%

Blood consumption in total arterial coronary artery bypass grafting

Werner

Lipps

Waldhans

et al. 2020

J Cardiothorac Surg

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Background: Accumulating evidence consistently demonstrates that blood transfusion in cardiac surgery is related to decreased short-and long-term survival. We aimed to evaluate periprocedural blood loss and transfusion rates in elective, isolated total arterial coronary artery bypass grafting (CABG) using exclusively skeletonized bilateral internal mammary arteries (IMAs). Methods: We identified 1011 consecutive patients with coronary artery disease who underwent CABG between 1/ 2007 and 12/2014. Of them, 595 patients who presented preoperative hemoglobin levels >9md/dl and underwent elective, isolated CABG for multi-vessel coronary artery disease were included in the study population. 419 patients (70.4%) received total arterial CABG using skeletonized bilateral IMAs, in 176 patients (29.6%) mixed CABG (single IMA & saphenous vein) was performed. Propensity score adjustment using 16 variables was applied to control for treatment effect. Results: In patients undergoing total arterial CABG, heterologous blood transfusion could be avoided in 87.8% of all cases. Propensity score adjusted results showed a significantly lower incidence of erythrocyte concentrate transfusion in patients undergoing total arterial CABG compared to mixed CABG (odds ratio 2.74, 95% confidence interval 1.38-5.43, P = 0.004). There were no statistically significant differences in the rates of thrombocyte concentrate (P = 0.39) and fresh frozen plasma transfusions (P = 0.07). Conclusions: In this study, patients who underwent elective, isolated total arterial CABG using exclusively skeletonized bilateral IMAs showed reduced transfusion rates of erythrocyte concentrates compared to mixed CABG using a combination of single IMA and saphenous vein grafts. No evidence for a higher incidence of complications was found with a total arterial approach.

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Section: Discussioncontrasting

confidence: 87%

Blood consumption in total arterial coronary artery bypass grafting

Werner

Lipps

Waldhans

et al. 2020

J Cardiothorac Surg

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“…Patients who died intra-operatively without blood product administration were also excluded from the analysis. All data were prospectively collected and recorded in computerised database registries that remained consistent over the study period [ 4 , 19 , 20 ]. Information about demographics, co-morbidities, medical and surgical history, operative details and post-operative events during the hospital stay were all registered.…”

Section: Methodsmentioning

confidence: 99%

Safety and efficacy of prothrombin complex concentrate as first-line treatment in bleeding after cardiac surgery

Cappabianca¹,

Mariscalco²,

Biancari³

et al. 2016

Crit Care

Self Cite

102

104

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BackgroundBleeding after cardiac surgery requiring surgical reexploration and blood component transfusion is associated with increased morbidity and mortality. Although prothrombin complex concentrate (PCC) has been used satisfactorily in bleeding disorders, studies on its efficacy and safety after cardiopulmonary bypass are limited.MethodsBetween January 2005 and December 2013, 3454 consecutive cardiac surgery patients were included in an observational study aimed at investigating the efficacy and safety of PCC as first-line coagulopathy treatment as a replacement for fresh frozen plasma (FFP). Starting in January 2012, PCC was introduced as solely first-line treatment for bleeding following cardiac surgery.ResultsAfter one-to-one propensity score–matched analysis, 225 pairs of patients receiving PCC (median dose 1500 IU) and FFP (median dose 2 U) were included. The use of PCC was associated with significantly decreased 24-h post-operative blood loss (836 ± 1226 vs. 935 ± 583 ml, p < 0.0001). Propensity score–adjusted multivariate analysis showed that PCC was associated with significantly lower risk of red blood cell (RBC) transfusions (odds ratio [OR] 0.50; 95 % confidence interval [CI] 0.31–0.80), decreased amount of RBC units (β unstandardised coefficient −1.42, 95 % CI −2.06 to −0.77) and decreased risk of transfusion of more than 2 RBC units (OR 0.53, 95 % CI 0.38–0.73). Patients receiving PCC had an increased risk of post-operative acute kidney injury (AKI) (OR 1.44, 95 % CI 1.02–2.05) and renal replacement therapy (OR 3.35, 95 % CI 1.13–9.90). Hospital mortality was unaffected by PCC (OR 1.51, 95 % CI 0.84–2.72).ConclusionsIn the cardiac surgery setting, the use of PCC compared with FFP was associated with decreased post-operative blood loss and RBC transfusion requirements. However, PCC administration may be associated with a higher risk of post-operative AKI.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1172-6) contains supplementary material, which is available to authorized users.

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“…Administration of clopidogrel should be stopped 5-7 days before the anticipated procedure if an antiplatelet effect is not desired (12,13). Clopidogrel takes 5-10 days to attain maximal platelet inhibition, so for postoperative patients who have adequate hemostasis, an initial loading dose (300-600 mg/d) usually is given to attain antiplatelet activity within 12-15 hours after administration (14).…”

Section: Perioperative Management Of Antiplatelet Agentsmentioning

confidence: 99%

Committee Opinion No 610

2014

Obstetrics &Amp; Gynecology

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Surgery can present a management dilemma for gynecologists whose patients receive chronic antithrombotic therapy because the risk of hemorrhagic complications must be balanced against the risk of thromboembolic complications. Interruption of antithrombotic therapy to reduce perioperative bleeding poses a significant risk of recurrent thromboembolic events. Patients who receive chronic antithrombotic therapy should be seen at least 7 days before a planned procedure, and each woman should be included in decision making regarding risks and benefits specific to her situation. The schedule may need to be altered if the international normalized ratio is at a high level and in patients older than 75 years of age (who may need more time to correct their international normalized ratio). The patient's cardiologist often will have recommendations for the appropriate bridging therapy for a specific valve or stent. A discussion of the risks and benefits of different management schemes for chronic antithrombotic therapy may involve the surgeon, the patient, the anesthesiologist, and the primary care physician.

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Optimal Timing of Discontinuation of Clopidogrel and Risk of Blood Transfusion After Coronary Surgery - Propensity Score Analysis -

Cited by 12 publications

References 34 publications

Blood consumption in total arterial coronary artery bypass grafting

Blood consumption in total arterial coronary artery bypass grafting

Safety and efficacy of prothrombin complex concentrate as first-line treatment in bleeding after cardiac surgery

Committee Opinion No 610

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