Emergency coronary artery bypass graft surgery in abciximab-treated patients

Background. Although the platelet antiaggregant abciximab is frequently use d with percutaneous coronary interventions, results of emergency coronary a rtery bypass graft operations in patients recently treated with abciximab a re poorly characterized. Methods. During a 29-month period, 12 patients required emergency coronary artery bypass grafting within 12 hours (mean, 1.9 hours) of abciximab thera py. Our full standard heparin dose regimen was used (mean heparin dose, 53, 000 U per patient). Each patient received a single platelet transfusion dos e after protamine administration, and further blood products were transfuse d as necessary. Clinical outcome and transfusion requirements were compared with predicted results based on risk-adjusted historical patients. Results. No patients died and none were returned to the operating room for coagulopathy-related bleeding. Per-patient transfusion requirements were as follows: red blood cells, 3.6 units; apheresis platelets, 1.4 units; and f resh frozen plasma, 1.5 units. As compared with predicted values, there was no excessive incidence of mortality, stroke, or red blood cell transfusion requirements. Conclusions. Emergency coronary artery bypass graft operations using full-d ose heparin can be performed successfully in acutely ischemic abciximab-tre ated patients. Prophylactic transfusion of platelets after protamine admini stration appears to be useful. (C) 2000 by The Society of Thoracic Surgeons .