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Is anticoagulation management more significant for patients undergoing off-pump bypass than for those after CABG?

Department of Cardiothoracic Surgery, University Hospital of Patras, 22500 Rion Patras, Greece

Different anticoagulation strategies in off-pump coronary artery bypass operations: a European survey

Actually, this survey confirms that there is a great variation as far as the strategy for OPCAB operations is concerned between several Cardiothoracic Departments [1]. As a result, the observed inhomogeneous practice regarding anticoagulation protocols, antiplatelet therapy, use of antifibrinolytics and the further lack of guidelines for OPCAB reflects the difficulty of even multi-center trials to lead to reliable conclusions [2]. Besides, the fact that a cell-server being a miniature of CPB – is used by 70% of surgeons may explain the report by several studies of comparable results between CABG and OPCAB concerning the incidence of stroke, SIRS, neuro-cognitive disorders, haemorrhage etc. [3]. The fact that 34% of surgeons consider OPCAB as an independent risk factor for the early occlusion of grafts [1], indicates that this surgical method has not yet been proved reliable. Also, it would be interesting to inform us which was the surgical experience (operations/year) of these surgeons. Moreover, the fact that two-thirds (67%) of surgeons support the postoperative administration of antiplatelet agents in combination with low-dose heparine reflects their fear of complications, not only of DVT – whose risk is relatively lower [4], but also the early thrombosis of anastomoses or grafts.

In our opinion, anticoagulation therapy plays a more significant role for the patients undergoing OPCAB compared with CABG, where there is a notable decreased coagulation ‘status’ (decreased platelets levels, hemodilution, consumption of coagulation factors, fibrinolysis, preoperative administration of antiplatelet agents and heparine, etc.) [5]. Consequently, the creation of guidelines concerning the optimal perioperative strategy during OPCAB remains an important aim to improve the early and late results.

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1. Englberger L, Streich M, Tevaearai HT, Carrel TP. Different anticoagulation strategies in off-pump coronary artery bypass operations: a European survey. Interact CardioVasc Thorac Surg 2008;7:378–383.[Abstract/Free Full Text]
2. Hansen KH, Hughes P, Steinbruchel DA. Antithrombotic- and anticoagulation regimens in OPCAB surgery. A Nordic survey. Scand Cardiovasc J 2005;39:369–374.[CrossRef][Medline]
3. Racz MJ, Hannan EL, Isom W, Subramanian VA, Jones RH, Gold JP, Ryan TJ, Hartman A, Culliford AT, Bennett E, Lancey RA, Rose EA. A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass surgery with sternotomy. J Am Coll Cardiol 2004;43:557–564.[Abstract/Free Full Text]
4. Cartier R, Robitaille D. Thrombotic complications in beating heart operations. J Thorac Cardiovasc Surg 2001;121:920–922.[Abstract/Free Full Text]
5. Wheatley D. The complications of coronary surgery. In: Wheatley D, ed. Surgery of Coronary Artery Disease. Arnold, London. 2003:237–238.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Google Scholar Articles by Apostolakis, E. Articles by Koniari, I. PubMed Articles by Apostolakis, E. Articles by Koniari, I. Related Collections Related Article