Ayten SARACOĞLU, Mehmet EZELSOY, Kemal Tolga SARACOĞLU

Withdrawal of Antithrombotic Agents and Its Impact on Thrombosis and Bleeding in Patients Undergoing Cardiac Surgery

INTRODUCTION: Our aim is to determine the incidence of thrombotic complications that may be associated with discontinuation of preoperative anticoagulants in patients undergoing open heart surgery. METHODS: The data of 512 adult patients undergoing elective open hearth surgery were evaluated. Patients treated with dual antiplatelet therapy were included and divided into two groups. Group 1 patients (n=255) have suspended their aspirin therapy prior to surgery. Group 2 patients (n=257) have not suspended. Demographics, cardiac reserves, preoperative and postoperative Htc levels, the types of anticoagulants, the transfusion of blood products, possible complications and mortality rates were recorded. RESULTS: The demographics, the duration of surgery, hospital and internal care unit (ICU) stay, cardiopulmonary bypass (CPB) time, mortality rate, reexploration rate, the need for transfusion did not differ between groups. The amount of platelet suspension in antithrombotic group was significantly higher than in group without antithrombotic agent (p ˂ 0.05). DISCUSSION AND CONCLUSION: Neither reexploration nor transfusion rates were different for cardiac patients on aspirin therapy. Therefore, aspirin did not increase the incidence of postoperative complications even for cardiac surgery, where heparinization and extra corporeal circulation are necessary. As aspirin has not a negative effect on patient outcomes, should not be discontinued in patients undergoing major surgery.

Antitrombotik Ajanların Preoperatif Kesilmesinin Tromboz ve Kanama Riski Üzerine Etkileri

GİRİŞ ve AMAÇ: Amacımız açık kalp ameliyatı geçiren hastalarda preoperatif antikoagülanların kesilmesi ile ilişkili olabilecek trombotik komplikasyonların insidansını belirlemektir. YÖNTEM ve GEREÇLER: Elektif açık kalp ameliyatı geçiren 512 erişkin hastanın verileri değerlendirildi. İkili antiplatelet tedavisi alan hastalar dahil edildi ve iki gruba ayrıldı. Grup 1’deki hastalar (n = 255) cerrahi öncesi aspirin tedavilerini askıya almış olup, Grup 2'deki hastalarda (n = 257) askıya alınmamıştır. Demografik özellikler, kalp rezervleri, preoperatif ve postoperatif Htc düzeyleri, antikoagülan türleri, kan ürünlerinin transfüzyonu, olası komplikasyonlar ve mortalite oranları kaydedildi. BULGULAR: Demografik özellikler, ameliyat süresi, hastane ve yoğun bakımda kalış süresi, Kardiyopulmoner Bypass zamanı, mortalite oranı, re-eksplorasyon oranı, transfüzyon ihtiyacı gruplar arasında farklılık göstermedi. Antitrombotik gruptaki transfüze edilen trombosit süspansiyonu miktarı, antitrombotik ajan içermeyen gruptan anlamlı olarak daha yüksekti (p ˂ 0.05). TARTIŞMA ve SONUÇ: Aspirin tedavisindeki kardiyak hastalar için ne re-eksplorasyon ne de transfüzyon oranları farklılık göstermemiştir. Üstelik aspirin, heparinizasyon ve ekstra korporeal dolaşımın gerekli olduğu kardiyak cerrahi için postoperatif komplikasyon insidansını artırmamıştır. Aspirinin hasta sonuçları üzerinde olumsuz bir etkisi bulunmadığından, major cerrahi geçiren hastalarda kesilmemesi gerektiği kanısına varılmıştır.

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