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| __NOTOC__
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| {{Coronary artery bypass surgery}}
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| {{CMG}}; {{AOEIC}} {{VK}}
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| ==ACCF/AHA Guidelines for Perioperative Bleeding/Transfusion<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=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. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>==
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| {{cquote|
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| ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
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| '''1.''' Lysine analogues are useful intraoperatively and postoperatively in patients undergoing on-pump CABG to reduce perioperative blood loss and transfusion requirements.<ref name="pmid18480196">{{cite journal |author=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 |title=A comparison of aprotinin and lysine analogues in high-risk cardiac surgery |journal=[[The New England Journal of Medicine]] |volume=358 |issue=22 |pages=2319–31 |year=2008 |month=May |pmid=18480196 |doi=10.1056/NEJMoa0802395 |url=http://dx.doi.org/10.1056/NEJMoa0802395 |accessdate=2011-12-19}}</ref><ref name="pmid19535691">{{cite journal |author=Greilich PE, Jessen ME, Satyanarayana N, Whitten CW, Nuttall GA, Beckham JM, Wall MH, Butterworth JF |title=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 |journal=[[Anesthesia and Analgesia]] |volume=109 |issue=1 |pages=15–24 |year=2009 |month=July |pmid=19535691 |doi=10.1213/ane.0b013e3181a40b5d |url=http://www.anesthesia-analgesia.org/cgi/pmidlookup?view=long&pmid=19535691 |accessdate=2011-12-19}}</ref><ref name="pmid16427545">{{cite journal |author=Kikura M, Levy JH, Tanaka KA, Ramsay JG |title=A double-blind, placebo-controlled trial of epsilon-aminocaproic acid for reducing blood loss in coronary artery bypass grafting surgery |journal=[[Journal of the American College of Surgeons]] |volume=202 |issue=2 |pages=216–22; quiz A44–5 |year=2006 |month=February |pmid=16427545 |doi=10.1016/j.jamcollsurg.2005.10.001 |url=http://linkinghub.elsevier.com/retrieve/pii/S1072-7515(05)01598-X |accessdate=2011-12-19}}</ref><ref name="pmid17664199">{{cite journal |author=Mehr-Aein A, Sadeghi M, Madani-civi M |title=Does tranexamic acid reduce blood loss in off-pump coronary artery bypass? |journal=[[Asian Cardiovascular & Thoracic Annals]] |volume=15 |issue=4 |pages=285–9 |year=2007 |month=August |pmid=17664199 |doi= |url=http://asianannals.ctsnetjournals.org/cgi/pmidlookup?view=long&pmid=17664199 |accessdate=2011-12-19}}</ref><ref name="pmid17244923">{{cite journal |author=Mehr-Aein A, Davoodi S, Madani-Civi M |title=Effects of tranexamic acid and autotransfusion in coronary artery bypass |journal=[[Asian Cardiovascular & Thoracic Annals]] |volume=15 |issue=1 |pages=49–53 |year=2007 |month=January |pmid=17244923 |doi= |url=http://asianannals.ctsnetjournals.org/cgi/pmidlookup?view=long&pmid=17244923 |accessdate=2011-12-19}}</ref><ref name="pmid16935098">{{cite journal |author=Murphy GJ, Mango E, Lucchetti V, Battaglia F, Catapano D, Rogers CA, Angelini GD |title=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 |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=132 |issue=3 |pages=475–80, 480.e1–8 |year=2006 |month=September |pmid=16935098 |doi=10.1016/j.jtcvs.2006.01.064 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(06)00861-0 |accessdate=2011-12-19}}</ref><ref name="pmid16400465">{{cite journal |author=Santos AT, Kalil RA, Bauemann C, Pereira JB, Nesralla IA |title=A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting |journal=[[Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Médicas E Biológicas / Sociedade Brasileira De Biofísica ... [Et Al.]]] |volume=39 |issue=1 |pages=63–9 |year=2006 |month=January |pmid=16400465 |doi=/S0100-879X2006000100007 |url=http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2006000100007&lng=en&nrm=iso&tlng=en |accessdate=2011-12-19}}</ref><ref name="pmid19103500">{{cite journal |author=Taghaddomi RJ, Mirzaee A, Attar AS, Shirdel A |title=Tranexamic acid reduces blood loss in off-pump coronary artery bypass surgery |journal=[[Journal of Cardiothoracic and Vascular Anesthesia]] |volume=23 |issue=3 |pages=312–5 |year=2009 |month=June |pmid=19103500 |doi=10.1053/j.jvca.2008.09.018 |url=http://linkinghub.elsevier.com/retrieve/pii/S1053-0770(08)00299-1 |accessdate=2011-12-19}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
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| '''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.<ref name="pmid7940165">{{cite journal |author=Paone G, Spencer T, Silverman NA |title=Blood conservation in coronary artery surgery |journal=[[Surgery]] |volume=116 |issue=4 |pages=672–7; discussion 677–8 |year=1994 |month=October |pmid=7940165 |doi= |url= |accessdate=2011-12-19}}</ref><ref name="pmid11388527">{{cite journal |author=Nuttall GA, Oliver WC, Santrach PJ, Bryant S, Dearani JA, Schaff HV, Ereth MH |title=Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass |journal=[[Anesthesiology]] |volume=94 |issue=5 |pages=773–81; discussion 5A–6A |year=2001 |month=May |pmid=11388527 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0003-3022&volume=94&issue=5&spage=773 |accessdate=2011-12-19}}</ref><ref name="pmid11573637">{{cite journal |author=Royston D, von Kier S |title=Reduced haemostatic factor transfusion using heparinase-modified thrombelastography during cardiopulmonary bypass |journal=[[British Journal of Anaesthesia]] |volume=86 |issue=4 |pages=575–8 |year=2001 |month=April |pmid=11573637 |doi= |url=http://bja.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=11573637 |accessdate=2011-12-19}}</ref><ref name="pmid14722166">{{cite journal |author=Avidan MS, Alcock EL, Da Fonseca J, Ponte J, Desai JB, Despotis GJ, Hunt BJ |title=Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery |journal=[[British Journal of Anaesthesia]] |volume=92 |issue=2 |pages=178–86 |year=2004 |month=February |pmid=14722166 |doi= |url=http://bja.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=14722166 |accessdate=2011-12-19}}</ref><ref name="pmid8178325">{{cite journal |author=Despotis GJ, Grishaber JE, Goodnough LT |title=The effect of an intraoperative treatment algorithm on physicians' transfusion practice in cardiac surgery |journal=[[Transfusion]] |volume=34 |issue=4 |pages=290–6 |year=1994 |month=April |pmid=8178325 |doi= |url= |accessdate=2011-12-19}}</ref><ref name="pmid9972747">{{cite journal |author=Shore-Lesserson L, Manspeizer HE, DePerio M, Francis S, Vela-Cantos F, Ergin MA |title=Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery |journal=[[Anesthesia and Analgesia]] |volume=88 |issue=2 |pages=312–9 |year=1999 |month=February |pmid=9972747 |doi= |url=http://www.anesthesia-analgesia.org/cgi/pmidlookup?view=long&pmid=9972747 |accessdate=2011-12-19}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
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| '''3.''' In patients taking [[thienopyridine]]s ([[clopidogrel]] or [[prasugrel]]) or [[ticagrelor]] in whom elective CABG is planned, clopidogrel and ticagrelor should be withheld for at least 5 days520,521,523,524,531,1058–1063 ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' and prasugrel for at least 7 days533 ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' before surgery.
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| '''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
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| '''5.''' [[Tirofiban]] or [[eptifibatide]] should be discontinued at least 2 to 4 hours before CABG and abciximab at least 12 hours before CABG.526–528,1049,1050,1064–1068 ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
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| ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
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| '''1.''' It is reasonable to consider off-pump CABG to reduce perioperative bleeding and allogeneic blood transfusion.67,1069–1074 ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''}}
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| ==Guidelines Resources==
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| *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<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=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. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>
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| ==References==
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| {{reflist|2}}
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| {{WH}}
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| {{WS}}
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| [[Category:Cardiac surgery]]
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| [[Category:Cardiology]]
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| [[Category:Surgery]]
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| [[Category:Surgical procedures]]
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