Emergency coronary artery bypass grafting: does excessive preoperative anticoagulation increase bleeding complications and transfusion requirements?

Patients requiring urgent surgical revascularization due to unstable corona ry artery disease are usually pretreated with multiple antithrombotic drugs . The perioperative risks of this type of treatment were investigated in 12 3 patients who underwent emergency coronary artery bypass grafting (CABG) a t our institution. Eighty-two patients (group A) received heparin and acetylsalicylic acid sol ely and 41 patients (group B) received additionally ADP-receptor antagonist s (82.9%), glycoprotein IIb/IIIa inhibitors (12.2%) or thrombolysis (14.6%) preoperatively. Both groups were similar regarding demographic data and ov erall clinical status. Preoperative coagulation parameters and intraoperati ve characteristics were comparable. Blood loss via chest tubes was not sign ificantly different between groups. Transfusion of red blood cells and fres h frozen plasma were slightly, but not significantly increased in group B. Transfusion of pooled platelets was low in general and similar in both grou ps. Re-exploration rate, medium intensive care unit and hospital stay as we ll as perioperative mortality were comparable. Excessive antithrombotic pretreatment seems to bear no additional risk in e mergency CABG and may be beneficial in this setting. (C) 2001 The Internati onal Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.