NoBlood

The effect of preoperative antiplatelet/anticoagulant prophylaxis on postoperative blood loss in cardiac surgery.

Pothula S, Sanchala VT, Nagappala B, Inchiosa MA Jr.

Department of Anesthesiology, New York Medical College, Valhalla, NY 10595, USA.

In this study we sought to determine whether preoperative treatment with antiplatelet and/or anticoagulant drugs influences postoperative blood loss after coronary artery bypass graft surgery. Although prophylactic treatment to prevent ischemic events preoperatively is often necessary, the treatment frequently continues until there may be a risk of increased bleeding (i.e., within 5-7 days before surgery). With patient consent, a preincision blood sample was collected prospectively from 93 adult subjects who presented randomly. They consisted of 3 groups regarding their primary preoperative regimen: 1) no preoperative treatment within the week before surgery; 2) platelet adenosine diphosphate (ADP) receptor antagonist; 3) ADP receptor antagonist plus IV heparin. Postoperative chest tube drainage (24 h) in the group that received ADP antagonist alone was more (P < 0.05) than either of the other groups: 503 +/- 56; 633 +/- 55; 439 +/- 29 mL (mean +/- SEM) for Groups 1, 2, and 3, respectively. Combined treatment with ADP antagonist plus heparin infusion appeared to prevent the increased blood loss with the ADP antagonist alone. Preincision and postoperative plasma fibrinogen concentrations were largest (P < 0.05) in the group that received the combination treatment; mean +/- SEM for groups 1, 2, and 3 preincision, 311 +/- 17, 366 +/- 16, and 423 +/- 18 mg/dL, and postoperatively, 229 +/- 16, 267 +/- 13, and 312 +/- 16 mg/dL. Postoperative fibrinogen showed strong dependence on preoperative fibrinogen in all groups (r = 0.576 to 0.825; P = 0.01 to 10(-6)). Prevention of the increased blood loss in the ADP receptor antagonist group by the addition of a heparin infusion may have been attributable to a conservation of coagulation factors, as evidenced by the increased plasma fibrinogen concentrations with combined prophylactic treatment. IMPLICATIONS: The objective of this study was to determine whether preoperative treatment with antiplatelet and/or anticoagulant drugs influences the extent of blood loss in the 24-h period after cardiac surgery.

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