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Cardiopulmonary bypass and dual antiplatelet therapy: a strategy to minimise transfusions and blood loss
- Source :
- Perfusion. 35:236-245
- Publication Year :
- 2019
- Publisher :
- SAGE Publications, 2019.
-
Abstract
- Background: Patients with preoperative dual antiplatelet therapy prior to coronary artery bypass surgery are at risk of bleeding and blood component transfusion. We hypothesise that an optimised cardiopulmonary bypass strategy reduces postoperative blood loss and transfusions. Methods: In total, 60 patients admitted for coronary artery bypass grafting with ticagrelor and aspirin medication withdrawn ® heparin-coated circuit with low systemic heparinisation (activated clotting time ® coated open circuit, full systemic heparinisation (activated clotting time > 480 seconds) and conventional cardiotomy suction. This perfusion strategy was evaluated by the chest drain volume after 24 hours, perioperative haemoglobin and platelet loss accompanied by global coagulation assessments. Results: Patients in the study group demonstrated significantly better outcomes signified by lower blood loss 554 ± 224 versus 1,100 ± 989 mL (p 9/L (p = 0.001). Indices of rotational thromboelastometry indicated shorter clotting times within the internal and external pathways. Adenosine diphosphate activated platelet function was within normal range based on Multiplate® aggregometry, while ROTEM® platelet analyses indicated inhibited function both preoperatively and post-bypass. Platelet inhibition by aspirin was verified throughout the perioperative period. Platelet function showed no intergroup differences. Conclusion: A stringent perfusion strategy reduced blood loss and transfusions in dual antiplatelet therapy patients requiring urgent surgery.
- Subjects :
- Advanced and Specialized Nursing
medicine.medical_specialty
business.industry
General Medicine
030204 cardiovascular system & hematology
law.invention
03 medical and health sciences
Coronary artery bypass surgery
0302 clinical medicine
030228 respiratory system
Platelet inhibitors
Blood loss
law
Blood Component Transfusion
Internal medicine
Cardiology
medicine
Cardiopulmonary bypass
Radiology, Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine
business
Safety Research
Subjects
Details
- ISSN :
- 1477111X and 02676591
- Volume :
- 35
- Database :
- OpenAIRE
- Journal :
- Perfusion
- Accession number :
- edsair.doi...........2b6d7babe9e9690f6e2ac33d1aba15e6
- Full Text :
- https://doi.org/10.1177/0267659119867005