Perioperative Management of Antiplatelet-Drugs in Cardiac Surgery

Abstract

The management of coronary patients scheduled for a coronary artery bypass grafting (CABG), who are receiving one or more antiplatelet drugs, is plenty of controversies. It has been shown that withdrawal of antiplatelet drugs is associated with an increased risk of a thrombotic event, but surgery under an altered platelet function also means an increased risk of bleeding in the perioperative period. Because of the conflict recommendations, this review article tries to evaluate the outcome of different perioperative antiplatelet protocols in patients with coronary artery disease undergoing CABG.

Platelet sequestration and activation during GalTKO.hCD46 pig lung perfusion by human blood is primarily mediated by GPIb, GPIIb/IIIa, and von Willebrand Factor

“…We hypothesize that this approach will not only be helpful to further improve lung function in xenograft models, but may also attenuate consumptive coagulopathy and thrombotic micrangiopathy that are observed in other organ xenograft models. Clinically, perioperative treatment with glycoprotein IIb/IIIa antagonists is known to potentially cause significant bleeding complications [46,47] and the use and time of drug administration has to be chosen carefully. In contrast, the 6B4 Fab antibody fragment inhibits shunt-associated platelet aggregation in vivo in baboons without causing thrombocytopenia (10% decrease of platelet counts) or prolongation of bleeding time [27], features suggesting that GPIb blockade will prove safe to use during surgery.…”

State-of-the-art blood conservation strategies following repair of aortic aneurysms and acute aortic dissection

“…This reduction may be achieved through the pre-, peri-and postoperative management of pharmacological adjuvants that decrease bleeding and pharmacological alternatives to stimulate erythropoiesis and increase oxygen transport. Routine use of antiplatelet drugs is limited where possible preoperatively (5,6). It is normal to continue acetylsalicylic acid preoperatively because there is good evidence that demonstrates adverse outcomes in cardiovascular and neurological end points when it is suddenly discontinued (5)…”

“…Routine use of antiplatelet drugs is limited where possible preoperatively (5,6). It is normal to continue acetylsalicylic acid preoperatively because there is good evidence that demonstrates adverse outcomes in cardiovascular and neurological end points when it is suddenly discontinued (5)…”

“…Almost all randomized controlled trials (RCTs) have shown that the use of restrictive transfusion therapy in euvolemic surgical patients does not increase the rates of postoperative morbidity or mortality, or the length of hospital stay, while it does reduce both the percentage of transfused patients and the volume of allogeneic blood administered (5) cardiac interventions (7,8). It has been assumed that patients with acute brain and/or cardiac dysfunction have worse outcomes being exposed to severe anemia (9).…”

The Antiagregant Treatment After Coronary Artery Surgery Depending on Cost – Benefit Report

“…It is necessary to avoid thrombotic complications maintaining the antiagregation, but balancing bleeding complications. [1] Combined antiplatelet therapy employing agents from different pharmacological classes is characterised by good safety and efficacy profiles.…”