Pericardial effusion after cardiac surgery: Incidence, relation to the type of surgery, antithrombotic therapy, and early coronary bypass graft patency

Ikäheimo, Markku J.; Huikuri, Heikki V.; Airaksinen, Juhani; Korhonen, Ulla R.; Linnaluoto, Markku K.; Tarkka, Matti; Takkunen, Juha T.

doi:10.1016/0002-8703(88)90255-4

Cited by 97 publications

(64 citation statements)

References 18 publications

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“…Similar to bleeding after cardiac surgery, therapeutic systemic anticoagulation (INR >2.5) was the only reported risk factor for cardiac tamponade after valvular surgery in another observational study not included in this review 85. No multivariate analysis on risk factors for cardiac tamponade or pericardial effusion was, however, presented in these studies 27, 75, 76, 85…”

Section: Resultsmentioning

confidence: 94%

“…The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta‐analyses (Tables 1 and 2). 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84 Of the 16 RCTs identified,1...…”

Section: Resultsmentioning

confidence: 99%

“…Although pericardial effusion was common after cardiac surgery (up to 84%),76 using different doses of enoxaparin (20 vs. 40 mg/day) for VTE prophylaxis after proximal aortic surgery did not affect the incidence of pericardial effusion (19% vs. 21%, respectively) nor the risk of cardiac tamponade requiring surgical interventions 75. Similarly, initiation of systemic anticoagulation for confirmed VTE also did not increase the risk of pericardial effusion in patients who took aspirin after CABG surgery 27.…”

Section: Resultsmentioning

confidence: 99%

“…Though these complications are not rare after surgery,76, 95, 96 whether low‐dose UFH or LMWH would substantially increase such risks remains scientifically unproven. In one large, retrospective cohort study, use of UFH or LMWH at 48 hours post‐CABG was not associated with an increased risk of bleeding compared to no VTE prophylaxis 19.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Bham

Pavey

2015

JAHA

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BackgroundOptimal thromboprophylaxis after cardiac surgery is uncertain. This systematic review aimed to define the incidence and risk factors for deep vein thrombosis (DVT), fatal and nonfatal pulmonary embolism (PE), and assess whether venous thromboembolism (VTE) prophylaxis was effective in reducing VTE without complications after cardiac surgery.Methods and ResultsTwo reviewers independently searched and assessed the quality and outcomes of randomized, controlled trials (RCTs) and observational studies on VTE after cardiac surgery in the MEDLINE, EMBASE, and Cochrane controlled trial register (1966 to December 2014). Sixty‐eight studies provided data on VTE outcomes or complications related to thromboprophylaxis after cardiac surgery. The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta‐analyses. VTE prophylaxis was associated with a reduced risk of PE (relative risk [RR], 0.45; 95% confidence interval [CI], 0.28–0.72; P=0.0008) or symptomatic VTE (RR, 0.44; 95% CI, 0.28–0.71; P=0.0006) compared to the control without significant heterogeneity. Median incidence (interquartile range) of symptomatic DVT, PE, and fatal PE were 3.2% (0.6–8.1), 0.6% (0.3–2.9), and 0.3% (0.08–1.7), respectively. Previous history of VTE, obesity, left or right ventricular failure, and prolonged bed rest, mechanical ventilation, or use of a central venous catheter were common risk factors for VTE. Bleeding or cardiac tamponade requiring reoperation owing to pharmacological VTE prophylaxis alone, without systemic anticoagulation, was not observed.ConclusionsUnless proven otherwise by adequately powered RCTs, initiating pharmacological VTE prophylaxis as soon as possible after cardiac surgery for patients who have no active bleeding is highly recommended.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Bham

Pavey

2015

JAHA

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“…8 The evidence with respect to the influence of antithrombotic therapy on pericardial effusion rates following cardiac surgery is scanty. In one series, echocardiography was per- 9 The pericardial effusion rate was 77% for both procedures and pericardial effusion was marked in 29% of cases. Pericardial effusion rates were not found to be related to antithrombotic therapy type.…”

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confidence: 97%

NICE thromboprophylaxis guidelines are not associated with increased pericardial effusion after surgery of the proximal thoracic aorta

Rahman

Hussain

Davies

et al. 2013

annals

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(40mg), early mobilisation and hydration. The 40mg enoxaparin dose over the previous 20mg regimen was worrisome, and its effect on pericardial effusion rates and mortality in proximal aortic surgery was investigated. METHODS Proximal aortic reconstructions performed between December 2008 and April 2011 were identified from prospectively collected data in a tertiary centre database. Retrospective analysis of patient notes was performed. Proximal aortic surgery patients were categorised as low dose (20mg) enoxaparin and high dose (40mg) enoxaparin, and compared for confounding variables. In-hospital, early and one-year readmission rates for pericardial effusion were ascertained from echocardiography reports. The primary outcome was total pericardial effusion rate. Secondary outcomes consisted of 30-day and 1-year mortality. RESULTS A total of 198 patients underwent proximal thoracic aortic surgery. Nine patients were excluded due to early postoperative death (n=5) and missing patient records (n=4). This left 189 cases for analysis. There were 93 patients in the low dose group and 96 in the high dose group. Groups were comparable for age, cardiopulmonary bypass time, aortic cross-clamp time, postoperative warfarin and antiplatelet agents. Pericardial effusion rates up to one year were comparable (low dose 19% vs high dose 21%). Thirty-day mortality was lower in the low dose group (0 vs 3 deaths). There were four deaths up to one year but these were not attributable to increased enoxaparin. CONCLUSIONS Increased perioperative thromboprophylaxis dosage does not increase pericardial effusion rates or mortality in proximal aortic surgery.

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Post‐ICU Care and Other Complications

2020

Manual of Perioperative Care in Adult Cardiac Surgery

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Pericardial effusion after cardiac surgery: Incidence, relation to the type of surgery, antithrombotic therapy, and early coronary bypass graft patency

Cited by 97 publications

References 18 publications

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

NICE thromboprophylaxis guidelines are not associated with increased pericardial effusion after surgery of the proximal thoracic aorta

Post‐ICU Care and Other Complications

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