Key result
An optimized cardiopulmonary bypass strategy significantly reduced postoperative blood loss (554 vs 1,100 mL, P<0.001) and packed red cell transfusions (7% vs 53%, P<0.001) in CABG patients on DAPT.
Why the study?
Patients receiving preoperative dual antiplatelet therapy prior to coronary artery bypass surgery are at risk of bleeding and blood component transfusion.
Does an optimized cardiopulmonary bypass strategy reduce blood loss and transfusions in patients undergoing CABG with recent dual antiplatelet therapy?
RCT (n=60)
1:1
Does an optimized cardiopulmonary bypass strategy reduce blood loss and transfusions in patients undergoing CABG with recent dual antiplatelet therapy?
Absolute Event Rate: 554% vs 1100%
p-value: p=<0.001
An optimized cardiopulmonary bypass strategy with a closed heparin-coated circuit, low systemic heparinization, and cell salvage significantly reduces blood loss and transfusion requirements in patients undergoing urgent CABG on recent DAPT.
May reduce bleeding/transfusions in ticagrelor patients; leaves open need for larger confirmatory trials.
Background: Patients with preoperative dual antiplatelet therapy prior to coronary artery bypass surgery are at risk of bleeding and blood component transfusion. We hypothesise that an optimised cardiopulmonary bypass strategy reduces postoperative blood loss and transfusions. Methods: In total, 60 patients admitted for coronary artery bypass grafting with ticagrelor and aspirin medication withdrawn <96 hours before surgery were prospectively randomised into two equal sized groups. Cardiopulmonary bypass combined a closed Cortiva ® heparin-coated circuit with low systemic heparinisation (activated clotting time < 250 seconds) and intraoperative cell salvage in the study group, whereas the control group used a Balance ® coated open circuit, full systemic heparinisation (activated clotting time > 480 seconds) and conventional cardiotomy suction. This perfusion strategy was evaluated by the chest drain volume after 24 hours, perioperative haemoglobin and platelet loss accompanied by global coagulation assessments. Results: Patients in the study group demonstrated significantly better outcomes signified by lower blood loss 554 ± 224 versus 1,100 ± 989 mL (p < 0.001), reduced packed red cell transfusion 7% versus 53% (p < 0.001), reduced haemoglobin −28 ± 15 versus −40 ± 14 g/L (p = 0.004) and platelet loss −35 ± 36 versus −82 ± 67 × 10 9 /L (p = 0.001). Indices of rotational thromboelastometry indicated shorter clotting times within the internal and external pathways. Adenosine diphosphate activated platelet function was within normal range based on Multiplate ® aggregometry, while ROTEM ® platelet analyses indicated inhibited function both preoperatively and post-bypass. Platelet inhibition by aspirin was verified throughout the perioperative period. Platelet function showed no intergroup differences. Conclusion: A stringent perfusion strategy reduced blood loss and transfusions in dual antiplatelet therapy patients requiring urgent surgery.
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Karlsson et al. (2019) conducted an RCT in Coronary artery bypass grafting on dual antiplatelet therapy (n=60). Optimised cardiopulmonary bypass strategy (closed heparin-coated circuit, low heparinisation, cell salvage) vs. Open circuit, full systemic heparinisation, and conventional cardiotomy suction was evaluated on Chest drain volume (blood loss) after 24 hours (p=<0.001). An optimized cardiopulmonary bypass strategy significantly reduced postoperative blood loss (554 vs 1,100 mL, P<0.001) and packed red cell transfusions (7% vs 53%, P<0.001) in CABG patients on DAPT.
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