medigraphic.com
SPANISH

Archivos de Cardiología de México

  • Contents
  • View Archive
  • Information
    • General Information        
    • Directory
  • Publish
    • Instructions for authors        
  • medigraphic.com
    • Home
    • Journals index            
    • Register / Login
  • Mi perfil

2004, Number 2

<< Back Next >>

Arch Cardiol Mex 2004; 74 (2)

Evaluation of predisposing factors for mediastinal bleeding in myocardial revascularization surgery. Role of acetylsalicylic acid, other platelet adhesion inhibitors, and anticoagulants

Campo AJA, Heredia PY, Ramos CVH, Barragán GR
Full text How to cite this article

Language: Spanish
References: 17
Page: 118-125
PDF size: 121.94 Kb.


Key words:

Mediastinal bleeding, Acetylsalicylic acid, Inhibitors of platelet adhesion, Anticoagulants, Mediastinal exploration, Coronary by-pass grafting.

ABSTRACT

Objective: To determine the main factors for perioperative mediastinal bleeding during coronary artery by-pass grafting and to establish the role of acetylsalicylic acid, other inhibitors of platelet adhesion, and anticoagulants in its occurrence. Methods: A multivariate analysis was performed to the data obtained from 251 patients subjected to coronary artery by-pass grafting in the year 2002. Results: There were no significant differences for the occurrence of perioperative bleeding induced by the preoperative administration of acetylsalicylic acid. No significant increment in the need for blood, platelet, or cryoprecipitates transfusion existed. Patients receiving non-fractionated or low molecular weight heparin had a significantly greater (p > 0.001) transoperative bleeding than patients without this drug. Administration of the other studied drugs did not increase either mediastinal bleeding or the need for blood derivatives. Conclusions: No statistical evidence was found to suspend administration of inhibitors of platelet adhesion in patients with coronary syndromes, subjected to coronary artery by-pass grafting. However, data obtained suggest the convenience of suspending administration of low molecular weight or non-fractionated heparin to patients subjected electively to coronary artery by-pass grafting.


REFERENCES

  1. Herwaldt LA, Swartzendruber SK, Zimmerman MB, Scholz DA, Franklin JA, Caldarone CA: Hemorrhage after coronary artery bypass graft procedures. Infect Control Hosp Epidemiol 2003; 24(1): 44-50.

  2. Dacey LJ, Munoz JJ, Baribeau YR, Johnson ER, Lahey SJ, Leavitt BJ, et al: Reexploration for hemorrhage following coronary artery bypass grafting: incidence and risk factors. Northern New England Cardiovascular Disease Study Group. Arch Surg 1998; 133(4): 442-7.

  3. Alvarez JM, Jackson LR, Chatwin C, Smolich JJ: Low-dose postoperative apportioning reduces mediastinal draining and blood product use in patients undergoing primary coronary artery bypass grafting who are taking aspirin: a prospective, randomized, double-bind, placebo-controlled trial. J Thorac Cardiovasc Surg 2001; 122(3): 457-63.

  4. Ray MJ, Hales MM, Brown L, O’Brien MF, Stafford EG: Postoperatively administered aprotinin or epsilon aminocaproic acid after cardiopulmonary bypass has limited benefit. Ann Thorac Surg 2001; 72(2): 521-6.

  5. Ferraris VA, Ferraris SP, Joseph O, Wehner P, Mentzer RM Jr: Aspirin and postoperative bleeding after coronary artery bypass grafting. Ann Surg 2002; 235(6): 820-7.

  6. Yende S, Wunderink RG: Effect of clopidogrel on bleeding after coronary artery bypass surgery. Crit Care Med 2001; 29(12): 2271-5.

  7. Bizzarri F, Scolletta S, Tucci E, Lucidi M, Davoli G, Toscano T, et al: Perioperative use of tirofiban hydrochloride (Aggrastat) does not increase surgical bleeding after emergency or urgent coronary artery bypass grafting. J Thorac Cardiovasc Surg 2001; 122(6): 1181-5.

  8. Jones HU, Muhlestein JB, Jones KW, Bair TL, Lavasani F, Sohrevardi M, et al: Preoperative use of enoxaparin compared with unfractionated heparin increases the incidence of re-exploration for postoperative bleeding after open-heart surgery in patients who present with an acute coronary syndrome: clinical investigation and reports. Circulation. 2002; 106(12 Suppl 1): 119-22.

  9. Clark SC, Vitale N, Zacharias J, Forty J: Effect of low molecular weight heparin (fragmin) on bleeding after cardiac surgery. Ann Thorac Surg. 2000; 69(3): 762-4; discussion 764-5.

  10. Izaguirre R: Manual de Medicina Transfusional. México. Instituto Nacional de Cardiología “Ignacio Chávez” 1993.

  11. Hall TS, Brevetti GR, Skoultchi AJ, Sines JC, Gregory P, Spotnitz AJ: Re-exploration for hemorrhage following open heart surgery differentiation on the causes of bleeding and the impact on patient outcomes. Ann Thorac Cardiovasc Surg 2001; 7(6): 352-7.

  12. Ascione R, Williams S, Lloyd CT, Sundaramoorthi T, Pitsis A, Angelini G: Reduced postoperative blood loss and Transfusion requirement after beating-heart coronary operations: A prospective randomized study. J Thorac Cardiovasc Surgery 2001; 121(4): 689-696.

  13. Dalrymple-Hay MJ, Dawkins S, Pack L, Deakin CD, Sheppard S, Ohri SK, et al: Autotransfusion decreases blood usage following cardiac surgery — A prospective randomized trial. Cardiovasc Surg 2001; 9(2): 184-7.

  14. Troianos CA, Sypula RW, Lucas DM, D’Amico F, Mathie TB, Desai M, et al: The effect of prophylactic epsilon-aminocaproic acid on bleeding, transfusions, platelet function, and fibrinolysis during coronary artery bypass grafting. Anesthesiology 1999; 91(2): 430-5.

  15. Mongan PD, Brown RS, Thwaites BK: Tranexamic acid and aprotinin reduce postoperative bleeding and transfusions during primary coronary revascularization. Anesth Analg 1998; 87(2): 258-65.

  16. Yellin A, Refaely Y, Paley M, Simansky D: Major bleeding complicating deep sternal infection after cardiac surgery. J Thorac Cardiovasc Surg 2003; 125(3): 554-8.

  17. Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M: Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg 1996; 111(5): 1037-46.




2020     |     www.medigraphic.com

Mi perfil

C?MO CITAR (Vancouver)

Arch Cardiol Mex. 2004;74