Coronary artery bypass surgery bleeding/transfusion

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[1]

Perioperative Bleeding/Transfusion (DO NOT EDIT)[1]

Class I
"1. Lysine analogues are useful intraoperatively and postoperatively in patients undergoing on-pump CABG to reduce perioperative blood loss and transfusion requirements.[2][3][4][5][6][7][8][9] (Level of Evidence: A)"
"2. A multimodal approach with transfusion algorithms, point-of-care testing, and a focused blood conservation strategy should be used to limit the number of transfusions.[10][11][12][13][14][15] (Level of Evidence: A)"
"3. In patients taking thienopyridines (clopidogrel or prasugrel) or ticagrelor in whom elective CABG is planned, clopidogrel and ticagrelor should be withheld for at least 5 days[16][17][18][19][20][21][22][23][24][25][26] (Level of Evidence: B) and prasugrel for at least 7 days[27] (Level of Evidence: C) before surgery."
"4. It is recommended that surgery be delayed after the administration of streptokinase, urokinase, and tissue-type plasminogen activators until hemostatic capacity is restored, if possible. The timing of recommended delay should be guided by the pharmacodynamic half-life of the involved agent. (Level of Evidence: C)"
"5. Tirofiban or eptifibatide should be discontinued at least 2 to 4 hours before CABG and abciximab at least 12 hours before CABG.[28][29][30][7][8][31][32][33][34][35] (Level of Evidence: B)"
Class IIa
"1. It is reasonable to consider off-pump CABG to reduce perioperative bleeding and allogeneic blood transfusion.[36][37][38][39][40][41][42] (Level of Evidence: A)"

Sources

  • 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[1]

References

  1. ↑ 1.0 1.1 1.2 Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
  2. ↑ Fergusson DA, Hébert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, Teoh K, Duke PC, Arellano R, Blajchman MA, Bussières JS, Côté D, Karski J, Martineau R, Robblee JA, Rodger M, Wells G, Clinch J, Pretorius R (2008). "A comparison of aprotinin and lysine analogues in high-risk cardiac surgery". The New England Journal of Medicine. 358 (22): 2319–31. doi:10.1056/NEJMoa0802395. PMID 18480196. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  3. ↑ Greilich PE, Jessen ME, Satyanarayana N, Whitten CW, Nuttall GA, Beckham JM, Wall MH, Butterworth JF (2009). "The effect of epsilon-aminocaproic acid and aprotinin on fibrinolysis and blood loss in patients undergoing primary, isolated coronary artery bypass surgery: a randomized, double-blind, placebo-controlled, noninferiority trial". Anesthesia and Analgesia. 109 (1): 15–24. doi:10.1213/ane.0b013e3181a40b5d. PMID 19535691. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  4. ↑ Kikura M, Levy JH, Tanaka KA, Ramsay JG (2006). "A double-blind, placebo-controlled trial of epsilon-aminocaproic acid for reducing blood loss in coronary artery bypass grafting surgery". Journal of the American College of Surgeons. 202 (2): 216–22, quiz A44–5. doi:10.1016/j.jamcollsurg.2005.10.001. PMID 16427545. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  5. ↑ Mehr-Aein A, Sadeghi M, Madani-civi M (2007). "Does tranexamic acid reduce blood loss in off-pump coronary artery bypass?". Asian Cardiovascular & Thoracic Annals. 15 (4): 285–9. PMID 17664199. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  6. ↑ Mehr-Aein A, Davoodi S, Madani-Civi M (2007). "Effects of tranexamic acid and autotransfusion in coronary artery bypass". Asian Cardiovascular & Thoracic Annals. 15 (1): 49–53. PMID 17244923. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  7. ↑ 7.0 7.1 Murphy GJ, Mango E, Lucchetti V, Battaglia F, Catapano D, Rogers CA, Angelini GD (2006). "A randomized trial of tranexamic acid in combination with cell salvage plus a meta-analysis of randomized trials evaluating tranexamic acid in off-pump coronary artery bypass grafting". The Journal of Thoracic and Cardiovascular Surgery. 132 (3): 475–80, 480.e1–8. doi:10.1016/j.jtcvs.2006.01.064. PMID 16935098. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  8. ↑ 8.0 8.1 Santos AT, Kalil RA, Bauemann C, Pereira JB, Nesralla IA (2006). "A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting". [[Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Médicas E Biológicas / Sociedade Brasileira De Biofísica ... [Et Al.]]]. 39 (1): 63–9. doi:/S0100-879X2006000100007 Check |doi= value (help). PMID 16400465. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  9. ↑ Taghaddomi RJ, Mirzaee A, Attar AS, Shirdel A (2009). "Tranexamic acid reduces blood loss in off-pump coronary artery bypass surgery". Journal of Cardiothoracic and Vascular Anesthesia. 23 (3): 312–5. doi:10.1053/j.jvca.2008.09.018. PMID 19103500. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  10. ↑ Paone G, Spencer T, Silverman NA (1994). "Blood conservation in coronary artery surgery". Surgery. 116 (4): 672–7, discussion 677–8. PMID 7940165. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  11. ↑ Nuttall GA, Oliver WC, Santrach PJ, Bryant S, Dearani JA, Schaff HV, Ereth MH (2001). "Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass". Anesthesiology. 94 (5): 773–81, discussion 5A–6A. PMID 11388527. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  12. ↑ Royston D, von Kier S (2001). "Reduced haemostatic factor transfusion using heparinase-modified thrombelastography during cardiopulmonary bypass". British Journal of Anaesthesia. 86 (4): 575–8. PMID 11573637. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  13. ↑ Avidan MS, Alcock EL, Da Fonseca J, Ponte J, Desai JB, Despotis GJ, Hunt BJ (2004). "Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery". British Journal of Anaesthesia. 92 (2): 178–86. PMID 14722166. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  14. ↑ Despotis GJ, Grishaber JE, Goodnough LT (1994). "The effect of an intraoperative treatment algorithm on physicians' transfusion practice in cardiac surgery". Transfusion. 34 (4): 290–6. PMID 8178325. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  15. ↑ Shore-Lesserson L, Manspeizer HE, DePerio M, Francis S, Vela-Cantos F, Ergin MA (1999). "Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery". Anesthesia and Analgesia. 88 (2): 312–9. PMID 9972747. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  16. ↑ Berger JS, Frye CB, Harshaw Q, Edwards FH, Steinhubl SR, Becker RC (2008). "Impact of clopidogrel in patients with acute coronary syndromes requiring coronary artery bypass surgery: a multicenter analysis". Journal of the American College of Cardiology. 52 (21): 1693–701. doi:10.1016/j.jacc.2008.08.031. PMID 19007688. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  17. ↑ Held C, Asenblad N, Bassand JP, Becker RC, Cannon CP, Claeys MJ, Harrington RA, Horrow J, Husted S, James SK, Mahaffey KW, Nicolau JC, Scirica BM, Storey RF, Vintila M, Ycas J, Wallentin L (2011). "Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery: results from the PLATO (Platelet Inhibition and Patient Outcomes) trial". Journal of the American College of Cardiology. 57 (6): 672–84. doi:10.1016/j.jacc.2010.10.029. PMID 21194870. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  18. ↑ Firanescu CE, Martens EJ, Schönberger JP, Soliman Hamad MA, van Straten AH (2009). "Postoperative blood loss in patients undergoing coronary artery bypass surgery after preoperative treatment with clopidogrel. A prospective randomised controlled study". European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 36 (5): 856–62. doi:10.1016/j.ejcts.2009.05.032. PMID 19616440. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  19. ↑ Herman CR, Buth KJ, Kent BA, Hirsch GM (2010). "Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery". The Annals of Thoracic Surgery. 89 (2): 397–402. doi:10.1016/j.athoracsur.2009.10.051. PMID 20103308. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  20. ↑ Kim JH, Newby LK, Clare RM, Shaw LK, Lodge AJ, Smith PK, Jolicoeur EM, Rao SV, Becker RC, Mark DB, Granger CB (2008). "Clopidogrel use and bleeding after coronary artery bypass graft surgery". American Heart Journal. 156 (5): 886–92. doi:10.1016/j.ahj.2008.06.034. PMID 19061702. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  21. ↑ Chu MW, Wilson SR, Novick RJ, Stitt LW, Quantz MA (2004). "Does clopidogrel increase blood loss following coronary artery bypass surgery?". The Annals of Thoracic Surgery. 78 (5): 1536–41. doi:10.1016/j.athoracsur.2004.03.028. PMID 15511426. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  22. ↑ Englberger L, Faeh B, Berdat PA, Eberli F, Meier B, Carrel T (2004). "Impact of clopidogrel in coronary artery bypass grafting". European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 26 (1): 96–101. doi:10.1016/j.ejcts.2004.03.030. PMID 15200986. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  23. ↑ Kapetanakis EI, Medlam DA, Petro KR, Haile E, Hill PC, Dullum MK, Bafi AS, Boyce SW, Corso PJ (2006). "Effect of clopidogrel premedication in off-pump cardiac surgery: are we forfeiting the benefits of reduced hemorrhagic sequelae?". Circulation. 113 (13): 1667–74. doi:10.1161/CIRCULATIONAHA.105.571828. PMID 16567570. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  24. ↑ Maltais S, Perrault LP, Do QB (2008). "Effect of clopidogrel on bleeding and transfusions after off-pump coronary artery bypass graft surgery: impact of discontinuation prior to surgery". European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 34 (1): 127–31. doi:10.1016/j.ejcts.2008.03.052. PMID 18455412. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  25. ↑ Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK (2001). "Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation". The New England Journal of Medicine. 345 (7): 494–502. doi:10.1056/NEJMoa010746. PMID 11519503. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  26. ↑ Vaccarino GN, Thierer J, Albertal M, Vrancic M, Piccinini F, Benzadón M, Raich H, Navia DO (2009). "Impact of preoperative clopidogrel in off pump coronary artery bypass surgery: a propensity score analysis". The Journal of Thoracic and Cardiovascular Surgery. 137 (2): 309–13. doi:10.1016/j.jtcvs.2008.08.002. PMID 19185143. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  27. ↑ Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM (2007). "Prasugrel versus clopidogrel in patients with acute coronary syndromes". The New England Journal of Medicine. 357 (20): 2001–15. doi:10.1056/NEJMoa0706482. PMID 17982182. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  28. ↑ Bizzarri F, Scolletta S, Tucci E, Lucidi M, Davoli G, Toscano T, Neri E, Muzzi L, Frati G (2001). "Perioperative use of tirofiban hydrochloride (Aggrastat) does not increase surgical bleeding after emergency or urgent coronary artery bypass grafting". The Journal of Thoracic and Cardiovascular Surgery. 122 (6): 1181–5. doi:10.1067/mtc.2001.117838. PMID 11726894. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  29. ↑ Dyke CM, Bhatia D, Lorenz TJ, Marso SP, Tardiff BE, Hogeboom C, Harrington RA (2000). "Immediate coronary artery bypass surgery after platelet inhibition with eptifibatide: results from PURSUIT. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrelin Therapy". The Annals of Thoracic Surgery. 70 (3): 866–71, discussion 871–2. PMID 11016325. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  30. ↑ Lincoff AM, LeNarz LA, Despotis GJ, Smith PK, Booth JE, Raymond RE, Sapp SK, Cabot CF, Tcheng JE, Califf RM, Effron MB, Topol EJ (2000). "Abciximab and bleeding during coronary surgery: results from the EPILOG and EPISTENT trials. Improve Long-term Outcome with abciximab GP IIb/IIIa blockade. Evaluation of Platelet IIb/IIIa Inhibition in STENTing". The Annals of Thoracic Surgery. 70 (2): 516–26. PMID 10969673. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  31. ↑ Renda G, Di Pillo R, D'Alleva A, Sciartilli A, Zimarino M, De Candia E, Landolfi R, Di Giammarco G, Calafiore A, De Caterina R (2007). "Surgical bleeding after pre-operative unfractionated heparin and low molecular weight heparin for coronary bypass surgery". Haematologica. 92 (3): 366–73. PMID 17339186. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  32. ↑ McDonald SB, Renna M, Spitznagel EL, Avidan M, Hogue CW, Moon MR, Barzilai B, Saleem R, McDonald JM, Despotis GJ (2005). "Preoperative use of enoxaparin increases the risk of postoperative bleeding and re-exploration in cardiac surgery patients". Journal of Cardiothoracic and Vascular Anesthesia. 19 (1): 4–10. doi:10.1053/j.jvca.2004.11.002. PMID 15747262. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  33. ↑ Jones HU, Muhlestein JB, Jones KW, Bair TL, Lavasani F, Sohrevardi M, Horne BD, Doty D, Lappe DL (2002). "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. 106 (12 Suppl 1): I19–22. PMID 12354703. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  34. ↑ Kincaid EH, Monroe ML, Saliba DL, Kon ND, Byerly WG, Reichert MG (2003). "Effects of preoperative enoxaparin versus unfractionated heparin on bleeding indices in patients undergoing coronary artery bypass grafting". The Annals of Thoracic Surgery. 76 (1): 124–8, discussion 128. PMID 12842525. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  35. ↑ Medalion B, Frenkel G, Patachenko P, Hauptman E, Sasson L, Schachner A (2003). "Preoperative use of enoxaparin is not a risk factor for postoperative bleeding after coronary artery bypass surgery". The Journal of Thoracic and Cardiovascular Surgery. 126 (6): 1875–9. doi:10.1016/S0022. PMID 14688699. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  36. ↑ Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, Collins P, Wang D, Sigwart U, Pepper J (2004). "A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery". The New England Journal of Medicine. 350 (1): 21–8. doi:10.1056/NEJMoa031282. PMID 14702424. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  37. ↑ Angelini GD, Taylor FC, Reeves BC, Ascione R (2002). "Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials". Lancet. 359 (9313): 1194–9. doi:10.1016/S0140-6736(02)08216-8. PMID 11955537. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  38. ↑ Cheng DC, Bainbridge D, Martin JE, Novick RJ (2005). "Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials". Anesthesiology. 102 (1): 188–203. PMID 15618803. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  39. ↑ Czerny M, Baumer H, Kilo J, Zuckermann A, Grubhofer G, Chevtchik O, Wolner E, Grimm M (2001). "Complete revascularization in coronary artery bypass grafting with and without cardiopulmonary bypass". The Annals of Thoracic Surgery. 71 (1): 165–9. PMID 11216739. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  40. ↑ Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, Leimbach M, Huber P, Garas S, Sammons BH, McCall SA, Petersen RJ, Bailey DE, Chu H, Mahoney EM, Weintraub WS, Guyton RA (2003). "Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting". The Journal of Thoracic and Cardiovascular Surgery. 125 (4): 797–808. doi:10.1067/mtc.2003.324. PMID 12698142. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  41. ↑ Raja SG, Dreyfus GD (2006). "Impact of off-pump coronary artery bypass surgery on postoperative bleeding: current best available evidence". Journal of Cardiac Surgery. 21 (1): 35–41, discussion 42–3. doi:10.1111/j.1540-8191.2006.00164.x. PMID 16426345. Retrieved 2011-12-19.
  42. ↑ van Dijk D, Nierich AP, Jansen EW, Nathoe HM, Suyker WJ, Diephuis JC, van Boven WJ, Borst C, Buskens E, Grobbee DE, Robles De Medina EO, de Jaegere PP (2001). "Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study". Circulation. 104 (15): 1761–6. PMID 11591611. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)

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