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Introduction
Cardiac surgery is inherently associated with increased bleeding and transfusion requirements.
The increased risk of bleeding is due to multiple factors; pharmacological (Intravenous
heparin and Dual Antiplatelet Therapy-DAPT), patient (advanced age, preoperative anaemia,
and female gender) and surgical (Emergency and redo surgery)1. This study aimed to
determine if preoperative antiplatelet medication influenced intraoperative blood
and blood products requirements during elective adult Isolated Coronary Artery Bypass
Graft (CABG) and valve surgery.
Methods
Methodology: A Prospective observational study carried out between September to November
2020, MMUH Ethical committee approval ref: CA20-064 on 12/10/2020. Perioperative data
were collected from fifty patients. This included demographic data, preoperative laboratories,
pre-Cardiopulmonary Bypass (CPB) heparin dose, Activated Clotting Time (ACT) at baseline,
post heparin and post protamine, blood products transfused and estimated blood loss
(EBL). The inclusion criteria applied was isolated CABG, single valve surgery and
elective operation. A one-paired Student t-test performed to detect a statistical
difference between the two groups (Isolated CABG Vs Single valve Surgery)
Results
31 patients met the inclusion criteria. 19 patients excluded because of the following
reasons: emergency surgery n=3, redo surgery n=1, New Oral Anticoagulants (NOACS)
medication n= 4, combined CABG & valve surgery/other n=12. 20 patients underwent an
isolated CABG, and 11 patients underwent a single valve operation. DAPT was prescribed
in 30% n=6/20 and 9% n=1/11 in the CABG and Valve group respectively.
There was no statistical difference in the EBL at the end of the procedure between
the two groups (CABG-624 ml Vs Valve-507 ml, p= 0.13). Intraoperative red cells transfusion
between the two groups were similar, however Octaplasma, fibrinogen and platelets
transfusion were higher in the valve group.
Discussion
DAPT were more frequently prescribed pre-operatively in patients undergoing elective
CABG in comparison to single valve surgery. Pre & postoperative haemoglobin and EBL
were similar between the two groups. Despite this, in the single valve surgery group
(only 1 patient out of 9 received DAPT, n=1/9) received more blood products during
the intraoperative period. This was statistically significant for the use of Octaplasma,
Platelets and fibrinogen. Blood transfusion was not directed using ROTEM in any patients
in either group. We, therefore, recommend the intraoperative use of ROTEM to guide
blood transfusion for patients undergoing isolated single valve surgery.
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© 2021 Published by Elsevier Inc.
