The Impact of Medical Therapy on Hemorrhagic Complications Following Coronary Artery Bypass Grafting

The treatment of acute myocardial infarction (MI) has evolved steadily over the past decade to include interventional modalities designed to restore blood flow to ischemically threatened myocardium. At present, intravenous thrombolytic therapy is the most widely used form of treatment given its availability, ease of administration, and proved efficacy. Percutaneous transluminal coronary angioplasty (PTCA) is also utilized in the early stages of MI and may have a distinct role in the setting of failed thrombolytic therapy "salvage PTCA" and cardiogenic shock. Emergent cardiac surgery, primarily bypass grafting but occasionally valve replacement as well, may be required for patients in whom (1) thrombolytic therapy fails or reocclusion occurs, (2) PTCA fails, (3) anatomy is unsuitable for PTCA, or (4) mechanical defects are correctable surgically. Of major concern, however, is the potential for hemorrhagic complications in surgical patients in whom (1) ongoing fibrinolytic activity is present or (2) hemostatic function is impaired.