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Eisenga J, Hocking J, Kluis A, DiMaio JM, Shih E, Schaffer J, Moore DO, Ryan W, Hutcheson K. A comprehensive deep venous thrombosis prophylaxis regimen in isolated coronary artery bypass grafting. JTCVS OPEN 2024; 17:145-151. [PMID: 38420549 PMCID: PMC10897659 DOI: 10.1016/j.xjon.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024]
Abstract
Objectives Deep venous thrombosis (DVT) is a known surgical complication that can lead to pulmonary embolism with subsequent morbidity and mortality. The incidence of DVT following coronary artery bypass grafting is unclear. Prophylaxis regimens vary and some guidelines advocate against use of routine chemoprophylaxis in patients at low-moderate risk for venous thromboembolism. We utilized postoperative lower extremity venous ultrasound to determine the incidence of DVT following coronary artery bypass grafting in patients with low- to moderate-risk of venous thromboembolism receiving aggressive postoperative DVT prophylaxis. Methods This is a single-center, retrospective study of all patients who underwent coronary artery bypass grafting between April 2022 and January 2023. All patients who completed postoperative venous ultrasound of the bilateral lower extremities were initially included. Patients who underwent concurrent valve or aortic surgery, were at high risk of venous thromboembolism, or were receiving anticoagulation therapy for nonvenous thromboembolism indications were excluded. The primary outcome was in-hospital incidence of DVT. Secondary outcomes were rates of mortality, postoperative bleeding, and thromboembolic events from discharge to 30 days postoperatively and from 30 days to 3 months postoperatively. Results No DVTs were observed in 211 included patients. In hospital, there were 3 significant bleeding events and 1 stroke. Following discharge there were 3 additional bleeding events, 1 death, 1 transient ischemic attack, and 1 pulmonary embolism. Conclusions We observed a 0% rate of DVT in low- to moderate-risk patients undergoing isolated coronary artery bypass grafting and receiving a comprehensive DVT prophylaxis regimen. In hospital bleeding and other thromboembolic event rates were 2.84% and 0.47% respectively.
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Affiliation(s)
- John Eisenga
- Department of Cardiovascular Research, Baylor Scott and White, The Heart Hospital, Plano, Tex
- Department of Surgery, Baylor University Medical Center, Dallas, Tex
- Baylor Scott and White Research Institute, Dallas, Tex
| | - Jennie Hocking
- Department of Cardiovascular Research, Baylor Scott and White, The Heart Hospital, Plano, Tex
- University of Texas Southwestern Medical School, Dallas, Tex
| | - Austin Kluis
- Department of Surgery, Baylor University Medical Center, Dallas, Tex
| | - J. Michael DiMaio
- Department of Cardiovascular Research, Baylor Scott and White, The Heart Hospital, Plano, Tex
- Department of Biomedical Engineering, Texas A&M University, College Station, Tex
| | - Emily Shih
- Department of Cardiovascular Research, Baylor Scott and White, The Heart Hospital, Plano, Tex
- Department of Surgery, Baylor University Medical Center, Dallas, Tex
| | - Justin Schaffer
- Department of Cardiovascular Research, Baylor Scott and White, The Heart Hospital, Plano, Tex
| | - David O. Moore
- Department of Cardiovascular Research, Baylor Scott and White, The Heart Hospital, Plano, Tex
| | - William Ryan
- Department of Cardiovascular Research, Baylor Scott and White, The Heart Hospital, Plano, Tex
| | - Kelley Hutcheson
- Department of Cardiovascular Research, Baylor Scott and White, The Heart Hospital, Plano, Tex
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Pumford EA, Rahman SM, Hlady V. Effect of upstream priming on transient downstream platelet-substrate interactions. Colloids Surf B Biointerfaces 2021; 206:111925. [PMID: 34175742 PMCID: PMC8429184 DOI: 10.1016/j.colsurfb.2021.111925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022]
Abstract
Upstream exposure of platelets to activating proteins 'primes' platelets for increased downstream adhesion, though the mechanics of platelet translocation before permanently arresting are not well understood. To investigate platelet translocation on platelet-binding proteins, primed platelets' transient contacts with immobilized proteins were recorded and analyzed. Using a microfluidic channel, representative of a vascular graft, platelet-activating proteins were covalently attached to the upstream priming, center, and downstream capture positions. Image sequences of platelet interactions with the center protein were captured as platelet-rich plasma (PRP) was perfused through the channel. There was an increase in both platelet pause events and net platelet adhesion on von Willebrand factor, collagen, or fibrinogen following upstream exposure to the same protein. Upstream priming also caused a decrease in average platelet velocity. The duration of transient platelet arrests on the protein-coated surface and the distance that platelets travel between pause events depended on the protein with which they were interacting. The most significant increase in platelet pause events frequency and decrease in average velocity occurred on immobilized von Willebrand factor, compared to the control with no upstream priming. These results demonstrate that platelet priming increases downstream platelet-protein interactions prior to permanent adhesion.
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Affiliation(s)
- Elizabeth Anne Pumford
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, 84112, USA
| | - Shekh Mojibur Rahman
- Department of Chemical Engineering, University of Utah, Salt Lake City, UT, 84112, USA
| | - Vladimir Hlady
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, 84112, USA.
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3
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Zhou J, Cao X, Du Y, Shi Y, Pan W, Jia S. Risk factors for acute pulmonary embolism in patients with off-pump coronary artery bypass grafting: implications for nursing. J Int Med Res 2021; 48:300060520971445. [PMID: 33249970 PMCID: PMC7708707 DOI: 10.1177/0300060520971445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective Acute pulmonary embolism (APE) is a serious complication after off-pump coronary artery bypass grafting (OPCABG). We aimed to analyze the risk factors for APE in patients with OPCABG. Methods In this retrospective, observational study, patients with OPCABG who were treated in our hospital from 1 January 2018 to 31 March 2020 were included. The basic characteristics of patients and results of preoperative laboratory examinations were collected and analyzed. Results A total of 707 patients with OPCABG were included and the incidence of APE was 3.21%. Left ventricular ejection fraction (LVEF), a history of smoking, number of bypass grafting, duration of surgery, and age were significant risk factors for APE in patients with OPCABG. The areas under the curves of LVEF, number of bypass grafting, duration of surgery, and age were 0.773, 0.759, 0.738, and 0.723, respectively. The cutoff values of LVEF, number of bypass grafting, duration of surgery, and age were 59.84, 3.18, 237.42, and 73.28, respectively. Conclusions LVEF, a history of smoking, number of bypass grafting, duration of surgery, and age may be risk factors for APE in patients with OPCABG. Early measures should be taken to target these risks to prevent APE.
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Affiliation(s)
- Jinli Zhou
- Jiangsu College of Nursing, Jiangsu, China
| | - Xiuhong Cao
- Department of Critical Care Medicine, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu, China
| | - Yeping Du
- Department of Critical Care Medicine, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu, China
| | - Yan Shi
- Department of Critical Care Medicine, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu, China
| | - Weiwei Pan
- Department of Critical Care Medicine, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu, China
| | - Suhong Jia
- Department of Critical Care Medicine, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu, China
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Carretta A, Lapenna E. Venous thromboembolism prophylaxis after minimally-invasive cardiac surgery: harm or benefit? J Thorac Dis 2020; 12:3469-3472. [PMID: 32802423 PMCID: PMC7399420 DOI: 10.21037/jtd.2020.03.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Angelo Carretta
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Pooria A, Pourya A, Gheini A. Postoperative complications associated with coronary artery bypass graft surgery and their therapeutic interventions. Future Cardiol 2020; 16:481-496. [PMID: 32495650 DOI: 10.2217/fca-2019-0049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Coronary artery disease is one of the commonest surgery demanding cardiovascular diseases. Coronary artery bypass graft surgery is practiced all over the world for the treatment of coronary artery disease. Systemic trauma during the surgery is associated with a wide range of complications, some of which are fatal. Preoperative risk factors such as age, previous illness and obesity are common predictors of these adverse events. Advances in therapeutic medicine have allowed timely treatment of these adverse events and co-morbidities. This review summarizes some of the most occurring complications associated with coronary artery bypass graft and corresponding treatment options.
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Affiliation(s)
- Ali Pooria
- Department of Cardiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Afsoun Pourya
- Student of Research committee, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Gheini
- Department of Cardiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Jannati M, Ardecani AA. Prevention of Pulmonary and Venous Thromboembolism Post Coronary Artery Bypass Graft Surgery - Literature Review. Braz J Cardiovasc Surg 2020; 35:368-374. [PMID: 32549108 PMCID: PMC7299585 DOI: 10.21470/1678-9741-2018-0345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective The current review evaluates recent literature on the different aspects of prophylaxis in postoperative pulmonary and venous thromboembolism and their main risk factors. Methods The literature survey was carried out based on the PubMed data using the keywords “coronary artery bypass graft” and “venous thromboembolism” as components of the search field title. Results Studies reported several risk factors for postoperative thromboembolism including advanced age, postoperative immobilization, type of thromboprophylaxis, obesity, and location of the surgery. Conclusion According to the studies, tailored prophylaxis could be easily adapted to decrease the intensity and duration of postoperative thromboembolism in a patient with several disorders and comorbidities, especially in cardiovascular disease.
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Affiliation(s)
- Mansour Jannati
- Shiraz University of Medical Sciences Faghihi Hospital Department of Cardiovascular Surgery Shiraz Iran Department of Cardiovascular Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Abdi Ardecani
- Shiraz University of Medical Sciences Faghihi Hospital Department of Cardiovascular Surgery Shiraz Iran Department of Cardiovascular Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Li W, Wang P, Le S, Xi W, Wang J, Yin L, Wang Q, Zhang Y, Wang Z. Benefits may not outweigh risks of low molecular weight heparin (LMWH) in early postoperative thromboprophylaxis following minimally invasive cardiac surgery: a propensity score-matched analysis. J Thorac Dis 2020; 11:5266-5273. [PMID: 32030244 DOI: 10.21037/jtd.2019.11.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Whether the benefits of early prophylactic anticoagulation by low molecular weight heparin (LMWH) would outweigh its possible harms in patients after minimally invasive cardiac surgery (MICS) remains contentious. The aims of this study were to define the incidence of venous thromboembolism (VTE) and to assess whether early prophylactic anticoagulation by LMWH postoperatively was indeed effective in reducing VTE without increasing risk of complications after MICS. Methods This investigation was a single-center, retrospective, propensity score-matched analysis study. A total of 473 patients underwent MICS, of whom 257 received prophylactic anticoagulation with LMWH (LMWH group) in the early postoperative period and 216 were not treated with LMWH (Control group). The main outcome measurements included the incidence of embolism events and major bleeding events, the volume of erythrocyte transfusion, the volume of drainage and the duration of drainage after MICS. In addition, the incidence of poor wound healing, the mechanical ventilation time, ICU stay time and postoperative hospitalization time were also documented. Results There were fewer embolic events (P=1.000) and a higher rate of major bleeding events (P=0.008) in the LMWH group than the Control group, and their magnitude and significance were maintained in the propensity matched analysis. In the matched cohorts, there was no significant difference in the total volume of red blood cell transfusion (P=0.552), assisted mechanical ventilation time (P=0.542), and the ICU stay time (P=0.166) between the two groups; while the volume of drainage (P<0.001) and the duration of drainage (P<0.001) in the LMWH group were significantly more than the Control group, and the incidence of poor wound healing (P=0.009) and the postoperative hospitalization time (P<0.001) were significantly increased in the LMWH group. Conclusions Early prophylactic anticoagulation with LMWH could not reduce the incidence of embolism events after MICS. Instead, it might increase postoperative major bleeding events and prolong drainage tube indwelling time and the length of hospital stay.
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Affiliation(s)
- Wei Li
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.,Department of Cardiothoracic Surgery, General Hospital of Central Theater Command, Wuhan 430012, China
| | - Pei Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Shiguan Le
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.,Department of Surgery, 69220 Hospital of Chinese People's Liberation Army, Kuqa County 842000, China
| | - Wang Xi
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Jing Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Liang Yin
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Qing Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Yufeng Zhang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
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Klingele M, Enkel J, Speer T, Bomberg H, Baerens L, Schäfers HJ. Bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative setting. J Cardiothorac Surg 2020; 15:27. [PMID: 31992340 PMCID: PMC6986048 DOI: 10.1186/s13019-020-1059-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/03/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES After elective cardiac surgery a postoperative anticoagulation is obligatory. With critically ill patients the conventional anticoagulation standard heparin is sometimes impossible, e.g. based on HIT II. Then, argatroban is currently a possible alternative, however, due to its impaired metabolism in critically ill patients, anticoagulation effect is harder to anticipate, thus resulting in higher bleeding risk. Furthermore, to date no antidote is available. Hence, severe postoperative bleeding incidents under anticoagulation are commonly mono-causal attributed to the anticoagulation itself. This study concentrates on the number of well-defined postoperative bleeding incidents before any anticoagulation started, then actually under argatroban as well as compared to those under heparin (or switched from heparin to argatroban). MATERIAL AND METHODS Retrospective study including 215 patients undergoing elective cardiac surgery with a postoperative stay in ICU ≥48 h. Postoperative bleeding complications before and after start of anticoagulation were evaluated. Definition of bleeding complications were: decrease of hemoglobin by more than 2 g/dl without dilution (mean value of volume balance plus one standard deviation) and/or increased need of red blood cell transfusion/day (average transfusion rate + 2 standard deviations). RESULTS Within the study group of 215 patients, 143 were treated with heparin, 43 with argatroban, 29 switched from heparin to argatroban. Overall, 26.5% (57/215) postoperative bleeding complications occurred. In 54.4% (31/57) bleeding complications occurred before start of anticoagulation; in 43.6% (26/57) after. Of these, 14 bleeding incidents occurred under heparin 9.8% (14/143), 6 under argatroban 14% (6/43) and 6 switched 20.7% (6/29). Higher bleeding complications before start of anticoagulation was related to concomitant factors influencing the overall bleeding risk; e.g. score of severity of illness. These observations further correlate with postoperative, but not anticoagulation induced mortality rate of 2.8% of then given heparin, 20.9% then argatroban, 20.7% then switched. CONCLUSIONS Postoperative bleeding complications cannot simply be attributed to anticoagulation since occurring often before anticoagulation was started. The risk for bleeding complications after start of anticoagulation was quite comparable for argatroban and heparin. Accordingly, the influence of argatroban on bleeding complications in the postoperative period may be less significant than previously thought.
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Affiliation(s)
- Matthias Klingele
- Department of Internal Medicine, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Saar, Germany. .,Department of Nephrology, Hochtaunuskliniken, Zeppelinstrasse 32, 61352, Bad Homburg, Germany.
| | - Julia Enkel
- Department of Internal Medicine, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Saar, Germany.,Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Centre, Homburg, Saar, Germany
| | - Timo Speer
- Department of Internal Medicine, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Saar, Germany
| | - Hagen Bomberg
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Centre, Homburg, Saar, Germany
| | - Lea Baerens
- Department of Nephrology, Hochtaunuskliniken, Zeppelinstrasse 32, 61352, Bad Homburg, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Centre, Homburg, Saar, Germany
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Du W, Zhao X, Nunno A, Li Y, Gu Y. Risk factors for venous thromboembolism in individuals undergoing coronary artery bypass grafting. J Vasc Surg Venous Lymphat Disord 2019; 8:551-557. [PMID: 31619374 DOI: 10.1016/j.jvsv.2019.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/17/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Venous thromboembolism (VTE) can easily occur after coronary artery bypass grafting (CABG). We assessed the proportion of patients with a diagnosis of VTE after CABG and determined the associated risk factors and complications in these patients. METHODS We assessed all the patients included in the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2015 who had undergone CABG. The demographic characteristics, surgical parameters, and complications were analyzed using single-factor and binary logistic regression analyses to identify the risk factors for VTE after CABG. RESULTS Overall, 8956 patients were identified. Postoperative VTE was found in 1.75% of these patients, with pulmonary embolism and deep vein thrombosis accounting for 0.61% and 1.28%, respectively; 0.15% of the patients had both conditions. The patients who had developed VTE had greater odds of being white and having an American Society of Anesthesiologists classification of ≥5. Multivariate analysis showed that a history of bleeding disorders, congestive heart failure, and operative time of ≥310 minutes were risk factors for the development of postoperative VTE. Patients with VTE had worse outcomes, including greater odds of returning to the operating room, hospitalization, unplanned reoperation, and readmission. The occurrence of VTE was associated with several postoperative complications, including emergency intubation, ventilator time >48 hours, pneumonia, urinary tract infection, peri- and postoperative transfusions, gradual kidney function reduction, acute kidney failure, cardiac arrest necessitating cardiopulmonary resuscitation, myocardial infarction, and septic shock. CONCLUSIONS The overall VTE rate after CABG has been low. However, the condition has been associated with worse 30-day postoperative outcomes and complications. The independent predictors of VTE development included a history of bleeding disorders, congestive heart failure in the 30 days before surgery, and operative time of ≥310 minutes. Understanding these risk factors should aid physicians in the decisions regarding prophylaxis and treatment.
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Affiliation(s)
- Wenting Du
- Department of Geriatrics, Affiliated Longhua Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China; Aab Cardiovascular Research Institute, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Xiaojie Zhao
- Department of Forensic Medicine, University of Nanjing Medical University, Nanjing, China
| | - Andrew Nunno
- Department of Medical Education, Washington University School of Medicine, St Louis, Mo
| | - Yan Li
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Bioinformatics, University of Nanjing Medical University, Nanjing, China
| | - Yun Gu
- Department of Geriatrics, Affiliated Longhua Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Panhwar MS, Ginwalla M, Kalra A, Gupta T, Kolte D, Khera S, Bhatt DL, Sabik JF. Association of Acute Venous Thromboembolism With In-Hospital Outcomes of Coronary Artery Bypass Graft Surgery. J Am Heart Assoc 2019; 8:e013246. [PMID: 31533551 PMCID: PMC6806036 DOI: 10.1161/jaha.119.013246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background While venous thromboembolism (VTE) prophylaxis is a strong recommendation after most surgeries, it is controversial in cardiac surgeries such as coronary artery bypass grafting (CABG), because of perceived low VTE incidence and increased bleeding risk. Prior studies may not have been adequately powered to study outcomes of VTE in this population. We sought to investigate the postoperative incidence and outcomes of CABG patients using a large national inpatient database. Methods and Results We utilized the 2013 to 2014 National Inpatient Sample to identify all patients >18 years of age who underwent CABG (without concomitant valvular procedures), and had VTE during the hospital stay. We then compared clinically relevant outcomes in patients with and without VTE. We identified 331 950 CABG procedures. Of these, 1.3% (n=4205) had VTE. Patients with VTE were more likely to be older (mean 67.2±10.4 years versus 65.2±10.4 years, P<0.001). VTE was associated with higher incidence of inpatient mortality (6.8% versus 1.7%; adjusted odds ratio 1.92 [95% CI 1.40–2.65]; P<0.001) and complications. VTE was also associated with higher cost (mean±SE $81 995±$923 versus $48 909±$55) and longer length of stay (mean±SE 17.06±0.16 days versus 8.52±0.01 days). Conclusions Our analysis of >330 000 CABG procedures suggests that while postoperative VTE after CABG is rare, it is associated with increased morbidity and mortality. Randomized controlled trials are needed to identify optimal strategies for VTE prophylaxis in these patients.
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Affiliation(s)
- Muhammad S Panhwar
- Tulane University Heart and Vascular Institute Tulane University School of Medicine New Orleans LA
| | - Mahazarin Ginwalla
- Division of Cardiovascular Medicine Harrington Heart & Vascular Institute University Hospitals Cleveland Medical Center Case Western Reserve University School of Medicine Cleveland OH
| | - Ankur Kalra
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland OH
| | - Tanush Gupta
- Montefiore Medical Center Albert Einstein College of Medicine New York NY
| | - Dhaval Kolte
- Massachusetts General Hospital Harvard Medical School Boston MA
| | - Sahil Khera
- Division of Cardiology Icahn School of Medicine at Mount Sinai New York New York
| | - Deepak L Bhatt
- Brigham & Women's Hospital Heart & Vascular Center Harvard Medical School Boston MA
| | - Joseph F Sabik
- Department of Surgery Harrington Heart & Vascular Institute University Hospitals Cleveland Medical Center Case Western Reserve University School of Medicine Cleveland OH
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11
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Liu X, Wang L, Wang S, Zhang W, Yu Y, Chen S, Ao H. Association Between Infection and Thrombosis After Coronary Artery Bypass Grafting: A Cohort Study. J Cardiothorac Vasc Anesth 2018; 33:1610-1616. [PMID: 30808554 DOI: 10.1053/j.jvca.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Surgery-related infection remains a major complication for patients undergoing cardiac surgery, and its association with thrombosis is unclear. This study aimed to examine the association of postoperative infection with thrombosis and major adverse cardiovascular and cerebral events (MACCEs) in patients undergoing coronary artery bypass grafting (CABG). DESIGN Retrospective cohort study. Multiple variable regression analyses were performed. SETTING The study was performed at a single institution. PARTICIPANTS All patients underwent CABG. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Perioperative and postoperative follow-up data relating to all CABG patients from January 2001 to August 2006 were queried from institutional electronic medical records of Fuwai Hospital, Beijing, China. Patients were divided into 2 groups according to whether they experienced infection. The study population comprised 75 patients who experienced infection and 2,926 control patients. Primary outcomes were a composite outcome of perioperative thrombosis and long-term thrombosis-related complications. Secondary outcomes were 5-year MACCEs postoperatively, including death, myocardial infarction, target vessel revascularization, and stroke. Risk factors for infection included older age, higher level of creatinine, chronic lung disease, cardiopulmonary bypass time, aortic cross-clamp time, history of renal failure, cardiopulmonary bypass, left ventricular assist device or intra-aortic balloon pump, length of stay in the intensive care unit, and duration of tracheal intubation. Infection increased the odds of perioperative thrombosis by 5.132-fold (95% confidence interval [CI] 2.040-12.911; p < 0.0001) compared with control. However, infection was not associated with a significant increase in MACCEs (hazard ratio 1.855, 95% CI 0.929-3.704; p = 0.080). Age was associated with a significant increase in MACCEs (hazard ratio 1.040, 95% CI 1.026-1.054; p < 0.0001). CONCLUSION There is an association between postoperative infection and perioperative thrombosis after CABG. Several specific management modalities were associated with controlling infection risk, which offers targets for future quality improvement.
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Affiliation(s)
- Xiaojie Liu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijuan Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sudena Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyuan Zhang
- Department of Anesthesiology, First Affiliated Hospital, Nangchang University, Nanchang City, Jiangxi Province, China
| | - Yang Yu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sipeng Chen
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hushan Ao
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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