2012 Update to The Society of Thoracic Surgeons Guideline on Use of Antiplatelet Drugs in Patients Having Cardiac and Noncardiac Operations

Division of Cardiovascular and Thoracic Surgery, University of Kentucky, Lexington, Kentucky. Electronic address: .
The Annals of thoracic surgery (Impact Factor: 3.85). 11/2012; 94(5):1761-81. DOI: 10.1016/j.athoracsur.2012.07.086
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Available from: Thomas Brett Reece, Mar 08, 2015
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    • "For patients who receive DAPT, the decision to defer the operation according to PFT results is more reasonabl6e than making a decision on the operation day according to the period of drug withdrawal. The optimal value of continuing aspirin alone or DAPT to prevent stent thrombosis or other ischemic events during cardiac and non-cardiac surgery is uncertain because of the lack of prospective trials [14] [15] [16]. The risk of bleeding is likely to be higher with DAPT than with aspirin alone or no antiplatelet therapy, but the magnitude of the increase is uncertain. "

    Thrombosis Research 06/2015; 136(3). DOI:10.1016/j.thromres.2015.06.018 · 2.45 Impact Factor
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    • "Clopidogrel also has its limitations, such as a delay in platelet block because the prodrug requires activation in the liver, and clopidogrel therapy is irreversible which can lead to increase bleeding and transfusion risk in cardiothoracic surgery (Power et al., 2012; Tam et al., 2012). Third generation thienopyridine prasugrel addressed the issue of delayed platelet blocking by being relatively independent of hepatic activation, however, it still remained irreversible and patients were still at risk for increase bleeding (Ferraris et al., 2012). Ticagrelor is an orally administered direct acting platelet blocker, which binds reversibly to the P2Y12receptor. "
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    Frontiers in Physiology 03/2014; 5:96. DOI:10.3389/fphys.2014.00096 · 3.53 Impact Factor
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    • "Multiple blood conservation strategies have thus been recommended for perioperative patient blood management in cardiac surgery [6] [7] [13]. Examples of such strategies include early cessation of antiplatelet and antithrombotic agents, acute normovolemic hemodilution, intraoperative cell scavenging, and the prophylactic use of tranexamic acid or ε-aminocaproic acid [7]. Furthermore, implementing transfusion algorithms has been repeatedly shown to reduce transfusion of allogeneic blood products [6] [14] [15]. "
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    ABSTRACT: The value of thrombelastography (TEG) and thromboelastometry (ROTEM) to improve perioperative hemostasis is under debate. We aimed to assess the effects of TEG- or ROTEM-guided therapy in patients undergoing cardiac surgery on the use of allogeneic blood products. We analyzed 12 trials including 6835 patients, 749 of them included in 7 randomized controlled trials (RCTs). We collected data on the amount of transfused allogeneic blood products and on the proportion of patients who received allogeneic blood products or coagulation factor concentrates. Including all trials, the odds ratios (ORs) for transfusion of red blood cell (RBC) concentrates, fresh-frozen plasma (FFP), and platelets were 0.62 (95% confidence interval [CI], 0.56-0.69; P<.001), 0.28 (95% CI, 0.24-0.33; P<.001), and 0.55 (95% CI, 0.49-0.62; P<.001), respectively. However, more than 50% of the patients in this analysis were derived from one retrospective study. Including RCTs only, the ORs for transfusion of RBC, FFP, and platelets were 0.54 (95% CI, 0.38-0.77; P<.001), 0.36 (95% CI, 0.25-0.53; P<.001), and 0.57 (95% CI, 0.39-0.81; P=.002), respectively. The use of coagulation factor concentrates was reported in 6 studies, 2 of them were RCTs. The ORs for the infusion of fibrinogen and prothrombin complex concentrate were 1.56 (95% CI, 1.29-1.87; P<.001) and 1.74 (95% CI, 1.40-2.18; P<.001), respectively. However, frequencies and amounts were similar in the intervention and control group in the 2 RCTs. It is presumed that TEG- or ROTEM-guided hemostatic management reduces the proportion of patients undergoing cardiac surgery transfused with RBC, FFP, and platelets. This presumption is strongly supported by similar ORs found in the analysis including RCTs only. Patient blood management based on the transfusion triggers by TEG or ROTEM appears to be more restrictive than the one based on conventional laboratory testing. However, evidence for improved clinical outcome is limited at this time.
    Transfusion medicine reviews 09/2013; 27(4). DOI:10.1016/j.tmrv.2013.08.004 · 2.92 Impact Factor
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