2014


To access this material please log in or register

Register Authorize
2014/№1

Administration of antiaggregants prior to coronary bypass

Altarev S. S., Barbarash O. L.
Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” at the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6, Kemerovo 650002

Keywords: antiaggregates, coronary heart disease, coronary bypass surgery,treatment

DOI: 10.18087/rhj.2014.1.1882

The requirement for antiplatelet therapy is growing. However, in some clinical situations, even a short-term withdrawal from antiaggregants is associated with increased risk of ischemic cardiovascular events. On the other hand, direct myocardial revascularization is associated with a risk for perioperative hemorrhagic and ischemic, and in these conditions. antiaggregation therapy may increase the incidence of postoperative hemorrhages. The article presents a review of literature focused on the use of antiaggregants prior to coronary bypass surgery.
  1. Covin R, O’Brien M, Grunwald G et al. Factors affecting transfusion of fresh frozen plasma, platelets, and red blood cells during elective coronary artery bypass graft surgery. Arch Pathol Lab Med. 2003;127 (4):415–423.
  2. Daly DJ, Myles PS, Smith JA et al. Anticoagulation, bleeding and blood transfusion practices in Australasian cardiac surgical practice. Anaesth Intensive Care. 2007;35 (5):760–768.
  3. Stover EP, Siegel LC, Parks R et al. Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines: a 24‑institution study. Anesthesiology. 1998;88 (2):327–333.
  4. Paone G, Brewer R, Theurer PF et al. Preoperative predicted risk does not fully explain the association between red blood cell transfusion and mortality in coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2012;143 (1):178–185.
  5. Borkent-Raven BA, Janssen MP, van der Poel CL et al. The PROTON study: profiles of blood product transfusion recipients in the Netherlands. Vox Sang. 2010;99 (1):54–64.
  6. Cobain TJ, Vamvakas EC, Wells A et al. A survey of the demogra­phics of blood use. Transfus. Med. 2007;17 (1):1–15.
  7. Popovsky MA. Transfusions and lung injury. Transfus Clin Biol. 2001;8 (3):272–277.
  8. Despotis GJ, Filos KS, Zoys TN et al. Factors associated with excessive postoperative blood loss and hemostatic transfusion requirements: a multivariate analysis in cardiac surgery patients. Anesth Analg. 1996;82 (1):13–21.
  9. Singh A, Doris J, Ferraris VA et al. The cost of excessive postope­rative blood transfusion after cardiac operations. Surg Forum. 1996;47:652–654.
  10. Alström U, Levin LÅ, Ståhle E et al. Cost analysis of re-exploration for bleeding after coronary artery bypass graft surgery. Br J Anaesth. 2012;108 (2):216–222
  11. Yende S, Wunderink RG. Effect of clopidogrel on bleeding after coronary bypass surgery. Crit Care Med. 2001;29 (12):2271–2275.
  12. Kuduvalli M, Oo A. Y, Newall N et al. Effect of peri-operative red blood cell transfusion on 30‑day and 1‑year mortality following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2005;27 (4):592–598.
  13. Murphy GJ, Reeves BC, Rogers CA et al. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation. 2007;116 (22):2544–2552.
  14. Lepelletier D, Perron S, Bizouarn P et al. Surgical-site infection after cardiac surgery: incidence, microbiology, and risk factors. Infect Control Hosp Epidemiol. 2005;26 (5):466–472.
  15. Murphy PJ, Connery C, Hicks GL Jr, Blumberg N. Homologous blood transfusion as a risk factor for postoperative infection after coronary artery bypass graft operations. J Thorac Cardiovasc Surg. 1992;104 (4):1092‑1‑99.
  16. Trowbridge CC, Stammers AH, Wood GC et al. Improved outcomes during cardiac surgery: a multifactorial enhancement of cardiopulmonary bypass techniques. J Extra Corpor Technol. 2005;37 (2):165–172.
  17. Spiess BD. Transfusion of blood products affects outcome in cardiac surgery. Semin Cardiothorac Vasc Anesth. 2004;8 (4):267–281.
  18. Choong CK, Gerrard C, Goldsmith KA et al. Delayed re-exploration for bleeding after coronary artery bypass surgery results in adverse outcomes. Eur J Cardiothorac Surg. 2007;31 (5):834–838.
  19. Frankel TL, Stamou SC, Lowery RC et al. Risk factors for hemor­rhage-related reexploration and blood transfusion after conventional versus coronary revascularization without cardiopulmonary bypass. Eur J Cardiothorac Surg. 2005;27 (3):494–500.
  20. Kristensen KL, Rauer LJ, Mortensen PE, Kjeldsen BJ. Reoperation for bleeding in cardiac surgery. Interact Cardiovasc Thorac Surg. 2012;14 (6):709–713.
  21. Munoz JJ, Birkemeyer NJ, Dacey LJ et al. Trends in rates of reexploration for hemorrhage after coronary artery bypass surgery. Ann Thorac Surg. 1999;68 (4):1321–1325.
  22. Hu S, Zheng Z, Yuan X et al. Coronary artery bypass graft: Contemporary heart surgery center performance in China. Circ. Cardiovasc. Circ Cardiovasc Qual Outcomes. 2012;5 (2):214–221.
  23. Mehta RH, Sheng S, O’Brien SM et al. Reoperation for bleeding in patients undergoing coronary artery bypass surgery incidence, risk factors, time trends, and outcomes. Circ Cardiovasc Qual Outcomes. 2009;2 (6):583–590.
  24. Ranucci M, Baryshnikova E, Castelvecchio S et al. Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thorac Surg. 2013;96 (2):478–485.
  25. Santos AA, Sousa AG, Thomé HO et al. Impact on early and late mortality after blood transfusion in coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc. 2013;28 (1):1–9.
  26. Mangano D. Multicenter Study of Perioperative Ischemia Research Group. Aspirin and mortality from coronary bypass surgery. N Engl J Med. 2002;347 (17):1309–1317.
  27. Devereaux PJ, Goldman L, Yusuf S et al. Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review. CMAJ 2005;173 (7):779–788.
  28. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft di­sea­se: pathogenesis, predisposition and treatment. Circulation. 1998;97 (9):916–931.
  29. Fabricius AM, Gerber W, Hanke M et al. Early angiographic control of perioperative ischemia after coronary artery bypass grafting. Eur J Cardiothorac Surg. 2001;19 (6):853–858.
  30. Levy J. H, Tanaka K. A. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 2003;75 (2):S715–20.
  31. Nalysnyk L, Fahrbach K, Reynolds MW et al. Adverse events in coronary artery bypass graft (CABG) trials: a systematic review and analysis. Heart. 2003;89 (7):767–72.
  32. Wolman R, Nussmeier NA, Aggarwal A et al. Cerebral injury after cardiac surgery: identification of a group at extraordinary risk. Stroke. 1999;30 (3):514–522.
  33. Stamou SC, Hill PC, Dangas G et al. Stroke After Coronary Artery Bypass Incidence, Predictors, and Clinical Outcome. Stroke. 2001;32 (7):1508–1513.
  34. Johnston SS, Bell K, Gdovin J et al. Coronary artery bypass graft surgery in acute coronary syndrome: incidence, cost impact, and acute clopidogrel interruption. Hosp Pract (1995). 2012;40 (1):15–23.
  35. Brizzio ME, Zapolanski A. Antiplatelet therapy, cardiac surgery, and the risk of bleeding: The Surgeon’s Perspective. Rev Cardiovasc Med. 2011;12 (Suppl 1):S40–46.
  36. Iakovou I, Schmidt T, Bonizzoni E et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-elu­ting stents. JAMA. 2005;293 (17):2126–2130.
  37. Kulkarni SP, Alexander KP, Lytle B et al. Long-term adherence with cardiovascular drug regimens. Am Heart J. 2006;151 (1):185–191.
  38. Rossini R, Capodanno D, Lettieri C et al. Prevalence, predictors, and long-term prognosis of premature discontinuation of oral antiplatelet therapy after drug eluting stent implantation. Am J Cardiol. 2011;107 (2):186–194.
  39. Sobolev BG, Fradet G, Hayden R et al. Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality. BMC Health Serv Res. 2008;8:185–192.
  40. Rexius H, Brandrup-Wognsen G, Odén A, Jeppsson A. Mortality on the waiting list for coronary artery bypass grafting: incidence and risk factors. Ann Thorac Surg. 2004;77 (3):769–774.
  41. Awtry EH, Loscalzo J. Aspirin. Circulation. 2000;101 (10):1206–1218
  42. Jimenez AH, Stubbs ME, Tofler GH et al. Rapidity and duration of platelet suppression by entericcoated aspirin in healthy young men. Am J Cardiol. 1992;69 (3):258–262.
  43. Beving H, Zhao C, Albåge A, Ivert T. Abnormally high platelet activity after discontinuation of acetylsalicylic acid treatment. Blood Coagul Fibrinolysis. 1996;7 (1):80–84.
  44. Biondi-Zoccai GG, Lotrionte M, Agostoni P et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J. 2006;27 (22):2667–2674.
  45. Collet JP, Montalescot G, Blanchet B et al. Impact of prior use or recent withdrawal of oral antiplatelet agents on acute coronary syndromes. Circulation. 2004;110 (16):2361–2367.
  46. Collet JP, Himbert F, Steg PG. Myocardial infarction after aspirin cessation in stable coronary artery disease patients. Int J Cardiol. 2000;76 (2-3):257–258.
  47. Ferrari E, Benhamou M, Cerboni P, Marcel B. Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis. J Am Coll Cardiol. 2005;45 (3):456–459.
  48. Burger W, Chemnitius JM, Kneissl GD, Rücker G. Low-dose aspirin for secondary cardiovascular prevention – cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation – review and meta-analysis. J Intern Med. 2005;257 (5):399–414.
  49. Albaladejo P, Geeraerts T, Francis F et al. Aspirin withdrawal and acute lower limb ischemia. Anesth Analg. 2004;99 (2):440–443.
  50. Vuylsteke A, Oduro A, Cardan E, Latimer RD. Effects of aspirin in coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 1997;11 (7):831–834.
  51. Sun JC, Whitlock R, Cheng J et al. The effect of pre-operative aspirin on bleeding, transfusion, myocardial infarction, and mortality in coronary artery bypass surgery: a systematic review of randomized and observational studies. Eur Heart J. 2008;29 (8):1057–1071.
  52. Muhlestein JB. Effect of antiplatelet therapy on inflammatory mar­kers in atherothrombotic patients. Thromb Haemost. 2010;103 (1):71–82.
  53. Bybee KA, Powell BD, Valeti U et al. Preoperative aspirin therapy is associated with improved postoperative outcomes in patients undergoing coronary artery bypass grafting. Circulation. 2005;112 (9 Suppl): I286–292.
  54. Dacey LJ, Munoz JJ, Johnson ER et al. Effect of preoperative aspirin use on mortality in coronary artery bypass grafting patients. Ann Thorac Surg. 2000;70 (6):1986–1990.
  55. Shim JK, Choi YS, Oh YJ et al. Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 2007;134 (1):59–64.
  56. Tuman KJ, McCarthy RJ, O’Connor CJ et al. Aspirin does not increase allogenic blood transfusion in reoperative coronary artery surgery. Anesth Analg. 1996;83 (6):1178–1184.
  57. Gulbins H, Malkoc A, Ennker IC, Ennker J. Preoperative platelet inhibition with ASA does not influence postoperative blood loss following coronary artery bypass grafting. Thorac Cardiovasc Surg. 2009;57 (1):18–21.
  58. Cao L, Young N, Liu H et al. Preoperative aspirin use and outcomes in cardiac surgery patients. Ann Surg. 2012;255 (2):399–404.
  59. Kremke M, Tang M, Bak M et al. Antiplatelet therapy at the time of coronary artery bypass grafting: a multicentre cohort study. Eur J Cardiothorac Surg. 2013;44 (2):e133–140.
  60. Hillis LD, Smith PK, Anderson JL et al. 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. 2011;124 (23):e652–735.
  61. Douketis JD, Spyropoulos AC, Spencer FA et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141 (2 Suppl): e326S-350S.
  62. Ferraris VA, Saha SP, Oestreich JH et al. 2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drugs in patients having cardiac and noncardiac operations. Ann Thorac Surg. 2012;94 (5):1761–1781.
  63. Patrono C, Baigent C, Hirsh J, Roth G. Antiplatelet drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133 (6 Suppl): 199S–233S.
  64. Weitz JI, Hirsh J, Samama MM; American College of Chest Physicians. New Antithrombotic Drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133 (6 Suppl): 234S–256S.
  65. Perakis PG, Yunus T, Long G et al. Platelet function after cessation of chronic clopidogrel therapy. Am Surg. 2012;78 (1):51–56.
  66. Price MJ, Walder JS, Baker BA et al. Recovery of platelet function after discontinuation of prasugrel or clopidogrel maintenance dosing in aspirin-treated patients with stable coronary disease: the recovery trial.J Am Coll Cardiol. 2012;59 (25):2338–2343.
  67. Mylotte D, Peace AJ, Tedesco AT et al.Clopidogrel discontinuation and plateletreactivity following coronary stenting. J Thromb Haemost. 2011;9 (1):24–32.
  68. Mitka M. Results of CURE trial for acute coronary syndrome. JAMA. 2001;285 (14):1828182–9.
  69. Steinhubl SR, Berger PB, Mann JT 3rd et al. CREDO Investigators. Clopidogrel for the Reduction of Events During Observation. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002;288 (19):2411–2420.
  70. Wiviott SD, Braunwald E, McCabe CH et al, for the TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357 (20):2001–2015.
  71. Alström U, Granath F, Friberg O et al. Risk factors for re-exploration due to bleeding after coronary artery bypass grafting. Scand Cardiovasc J. 2012;46 (1):39–44.
  72. Smith PK, Goodnough LT, Levy JH et al. Mortality benefit with prasugrel in the TRITON-TIMI 38 coronary artery bypass grafting cohort: risk-adjusted retrospective data analysis. J Am Coll Cardiol. 2012;60 (5):388–396.
  73. Nijjer SS, Watson G, Athanasiou T, Malik IS. Safety of clopidogrel being continued until the time of coronary artery bypass grafting in patients with acute coronary syndrome: a meta-analysis of 34 studies. Eur Heart J. 2011;32 (23):2970–2988.
  74. Vorobcsuk A, Aradi D, Farkasfalvi K et al. Outcomes of patients receiving clopidogrel prior to cardiac surgery. Int J Cardiol. 2012;156 (1):34–40.
  75. Kunadian B, Thornley AR, Tanos M, Dunning J. Should clopidogrel be stopped prior to urgent cardiac surgery? Interact Cardiovasc Thorac Surg. 2006;5 (5):630–636.
  76. Biancari F, Airaksinen KE, Lip GY. Benefits and risks of using clopidogrel before coronary artery bypass surgery: systematic review and meta-analysis of randomized trials and observational studies. J Thorac Cardiovasc Surg. 2012;143 (3):665–675.e4.
  77. Au AG, Majumdar SR, McAlister FA. Preoperative thienopyridine use and outcomes after surgery: a systematic review. Am J Med. 2012;125 (1):87–99.e1.
  78. Morici N, Moja L, Rosato V et al. Time from adenosine di-phosphate receptor antagonist discontinuation to coronary bypass surgery in patients with acute coronary syndrome: Meta-analysis and meta-regression. Int J Cardiol. 2013;168 (3):1955–1964.
  79. Herman CR, Buth KJ, Kent BA et al. Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery. Ann Thorac Surg. 2010;89 (2):397–402.
  80. Holinski S, Claus B, Barajas T et al. Cerebroprotective effect of preoperative dual antiplatelet therapy in patients undergoing coronary bypass surgery. Ann Thorac Cardiovasc Surg. 2013 Jan 31. [Epub ahead of print].
  81. Menkis AH, Martin J, Cheng DC et al. Drug, Drug, devices, technologies, and techniques for blood management in minimally invasive and conventional cardiothoracic surgery: a consensus statement from the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) 2011. Innovations (Phila). 2012;7 (4):229–241.
  82. Cannon CP, Husted S, Harrington RA et al. Safety, tolerability, and initial efficacy of AZD6140, the first reversible oral adeno­sine diphosphate receptor antagonist, compared with clopidogrel, in patients with non-ST-segment elevation acute coronary syndrome: primary results of the DISPERSE-2 trial. J Am Coll Cardiol. 2007;50 (19):1844–1851.
  83. Giannitsis E, Katus HA. Antiplatelet therapy – ticagrelor. Hamostaseologie. 2012;32 (3):177–85.
  84. Storey RF, Bliden KP, Ecob R et al. Earlier recovery of platelet function after discontinuation of treatment with ticagrelor compared with clopidogrel in patients with high antiplatelet responses. J Thromb Haemost. 2011;9 (9):1730–1737.
  85. Wallentin L, Becker R. C, Budaj A et al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med. 2009;361 (11):1045–1057.
  86. Hall R, Mazer CD. Antiplatelet drugs: a review of their pharmaco­logy and management in the perioperative period. Anesth Analg. 2011;112 (2):292–318.
  87. Kastrati A, Ndrepepa G. Cangrelor – a champion lost in translation? N Engl J Med. 2009;361 (24):2382–2384.
  88. Husted S, Harrington RA, Cannon CP et al. Bleeding risk with AZD6140, a reversible P2Y12 receptor antagonist, vs. clopidogrel in patients undergoing coronary artery bypass graf­ting in the DISPERSE2 trial. Intern. Int J Clin Pract. 2009;63 (4):667–670.
  89. Held C, Asenblad N, Bassand JP et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery, results from the PLATO. J Am Coll Cardiol. 2011;57 (6):672–684
  90. Angiolillo DJ, Firstenberg MS, Price MJ et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: A randomized controlled trial. JAMA. 2012;307 (3):265–274.
  91. Eikelboom JW, Hirsh J, Spencer FA et al. Antiplatelet Drugs: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141 (2 Suppl): e89S–119S
  92. Faulds D, Sorkin EM. Abciximab (c7E3 Fab). A review of its pharmacology and therapeutic potential in ischaemic heart disease. Drugs. 1994;48 (4):583–598.
  93. Gammie JS, Zenati M, Kormos RL et al. Abciximab and excessive bleeding in patients undergoing emergency cardiac operations. Ann Thorac Surg. 1998;65 (2):465–469.
  94. Phillips DR, Scarborough RM. Clinical pharmacology of eptifibatide. Am J Cardiol. 1997;80 (4A): 11B-20B.
  95. Broad L, Lee T, Conroy M et al. Successful management of patients with a drug-eluting coronary stent presenting for elective, non-cardiac surgery. Br J Anaesth. 2007;98 (1):19–22.
  96. Bigalke B, Seizer P, Geisler T et al. Perioperative antiplatelet therapy in patients at risk for coronary stent thrombosis undergoing noncardiac surgery. Clin Res Cardiol. 2009;98 (5):335–339.
  97. Savonitto S, D’Urbano M, Caracciolo M et al. Urgent surgery in patients with a recently implanted coronary drug-eluting stent: a phase II study of ‘bridging’ antiplatelet therapy with tirofiban du­ring temporary withdrawal of clopidogrel. Br J Anaesth. 2010;104 (3):285–291.
  98. Marcos EG, Da Fonseca AC, Hofma SH. Bridging therapy for early surgery in patients on dual antiplatelet therapy after drug-eluting stent implantation. Neth Heart J. 2011;19 (10):412–417.
  99. Alshawabkeh L, Prasad A, Lenkovsky F. Outcomes of a preoperative «bridging» strategy with glycoprotein IIb / IIIa inhibitors to prevent perioperative stent thrombosis in patients with drug-eluting stents who undergo surgery necessitating interruption of thienopyridine administration. EuroIntervention. 2013;9 (2):204–211.
  100. Rassi AN, Blackstone E, Militello MA et al. Safety of «bridging» with eptifibatide for patients with coronary stents before cardiac and non-cardiac surgery. Am J Cardiol. 2012;110 (4):485–490.
  101. Bizzarri F, Scolletta S, Tucci E 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):1181–1185.
  102. Dyke CM, Bhatia D, Lorenz TJ et al. 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. Ann Thorac Surg. 2000;70 (3):866–871.
  103. Korte W, Cattaneo M, Chassot PG et al. Peri-operative management of antiplatelet therapy in patients with coronary artery disease: joint position paper by members of the working group on Perioperative Haemostasis of the Society on Thrombosis and Haemostasis Research (GTH), the working group on Perioperative Coagulation of the Austrian Society for Anesthesiology, Resuscitation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society for Cardiology (ESC). Thromb Haemost. 2011;105 (5):743–749.
  104. Abualsaud AO, Eisenberg MJ. Perioperative management of patients with drug-eluting stents. JACC Cardiovasc Interv. 2010;3 (2):131–142.
Altarev S. S., Barbarash O. L. Administration of antiaggregants prior to coronary bypass. Russian Heart Journal. 2014;75 (1):32–44

To access this material please log in or register

Register Authorize
Ru En