Emergency coronary artery bypass graft surgery in abciximab-treated patients.
BACKGROUND
Although the platelet antiaggregant abciximab is frequently used with percutaneous coronary interventions, results of emergency coronary artery bypass graft operations in patients recently treated with abciximab are poorly characterized.


METHODS
During a 29-month period, 12 patients required emergency coronary artery bypass grafting within 12 hours (mean, 1.9 hours) of abciximab therapy. Our full standard heparin dose regimen was used (mean heparin dose, 53,000 U per patient). Each patient received a single platelet transfusion dose after protamine administration, and further blood products were transfused as necessary. Clinical outcome and transfusion requirements were compared with predicted results based on risk-adjusted historical patients.


RESULTS
No patients died and none were returned to the operating room for coagulopathy-related bleeding. Per patient transfusion requirements were as follows: red blood cells, 3.6 units; apheresis platelets, 1.4 units; and fresh frozen plasma, 1.5 units. As compared with predicted values, there was no excessive incidence of mortality, stroke, or red blood cell transfusion requirements.


CONCLUSIONS
Emergency coronary artery bypass graft operations using full-dose heparin can be performed successfully in acutely ischemic abciximab-treated patients. Prophylactic transfusion of platelets after protamine administration appears to be useful.
Lemmer
J H
JH
Northwest Surgical Associates, Legacy Portland Hospitals, Portland, Oregon, USA. jlemmerjr@aol.com
Metzdorff
M T
MT
Krause
A H
AH
Martin
M A
MA
Okies
J E
JE
Hill
J G
JG
D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000145:classification; D001026:Coronary Artery Bypass; D017707:Erythrocyte Transfusion; D005260:Female; D005544:Forecasting; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006494:Heparin Antagonists / Q000627:therapeutic use; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery / Q000628:therapy; D010949:Plasma; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D017713:Platelet Transfusion; D010983:Plateletpheresis; D011479:Protamines / Q000627:therapeutic use; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D006494:Heparin Antagonists; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011479:Protamines; D006493:Heparin; D000077284:Abciximab