Preoperative lipid-control with simvastatin reduces the risk of postoperative thrombocytosis and thrombotic complications following CABG

Objective: It has earlier been suggested that postoperative thrombocytosis frequently occur after coronary artery bypass grafting (CABG) and may be li nked to lipid disturbances. A prospective randomized study was undertaken t o evaluate if preoperative lipid-control, using HMG-CoA-reductase inhibitor (Zocor(R)), simvastatin, reduces the risk of postoperative thrombocytosis. Methods: Seventy-seven patients with symptomatic coronary artery disease a nd hypercholesterolemia (total cholesterol greater than or equal to 6.2 mmo l/l), planned for CABG where randomly assigned to; undergo CABG without pre operation lipid control (group I, n = 37) or undergo simvastatin-treatment (20 mg daily) to control their lipids (4 weeks) prior to CABG (group II, n = 40). Results: Patient characteristics and operation data did not differ b etween the groups. Serum-cholesterol, cholesterol/HDL-cholesterol, LDL-chol esterol, Apolipoprotein A1 and Plasminogen were all significantly higher in group I patients compared with group n just prior to surgery. Other labora tory parameters did not differ. Results: In group II, total cholesterol and cholesterol/HDL-cholesterol quota were significantly lowered by simvastati n (-2 and -29%, respectively). Postoperative thrombocytosis (platelet count s greater than or equal to 400 000/mu l) occurred significantly more freque ntly in group I 81% (30/37) compared with 3% (1/40) in group II, P < 0.0001 . Myocardial infarction after the 7th postoperative day was more often diag nosed in group I, 14 vs. 0% in group II. Postoperative transient renal fail ure occurred also more frequently in group I, 24% compared with 8% in group II. Other postoperative complications and laboratory data did not differ. Conclusions: This study once again underlines the importance of lipid contr ol using HMG-CoA-reductase inhibitors (e.g. Zocor(R)) in patients with esta blished coronary artery disease. For the first time it is shown that lipid- control with simvastatin prior to CABG reduces the risk of postoperative th rombocytosis, thus lowers the risk for thrombotic complications. (C) 1999 E lsevier Science B.V. All rights reserved.