[Myocardial revascularization after pretreatment with the GPIIb/IIIa receptor blocker abciximab].
OBJECTIVE
The present prospective study analysis whether preoperative abciximab treatment 1) increases perioperative risks, 2) alters the quality of the surgical treatment, 3) whether secondary organ complications occur and 4) whether and how the perioperative surgical management has to be modified.


METHODS
The perioperative results of patients operated upon after preoperative abciximab treatment (n = 31, 1/1994-4/2000) were compared with an optimal control group (elective patients and no preoperative intervention in the hemostaseological system) and with other patients (elective, urgent, emergency operations) receiving different strategies of preoperative hemostaseological interventions (n = 926, 1/1994-4/2000). All patients were operated upon with a well-defined strategy (one surgeon). 1100 perioperative items/patient were prospectively recorded and analyzed. The 30-day and 6 month follow-up was complete.


RESULTS
The mean time interval between end of abciximab therapy and onset of operation was 4.3 h (range: 36-0.5 h, median: 2 h). As compared with the optimal control group (n = 81), perioperative blood loss and the need for substitution of blood and blood products was increased. However, as compared with those patients receiving any type of preoperative intervention in the hemostaseological system (the majority of the patients), no difference was observed regarding intraoperative parameters (duration of extracorporeal circulation and of the operation) and postoperative results (neurological, renal complications, myocardial infarction, psychiatric disturbances, etc.) when abciximab patients were compared with the reference populations. No patient of the abciximab group died within 30 days or during the 6 month follow-up period.


CONCLUSIONS
The data show that coronary artery bypass grafting can be performed with similar results in abciximab-pretreated patients as in patients with other types of preoperative anticoagulation. Only slight modifications of the surgical management are recommended. As indicated by similar use IMA-grafts the quality of surgical treatment was not reduced.
Vahl
C F
CF
Klinik für Herzchirurgie Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Kayhan
N
N
Thomas
G
G
Bode
C
C
Hagl
S
S
D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000503:physiopathology*; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006452:Hemoglobinometry; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000009:adverse effects*; D019934:International Normalized Ratio; D008297:Male; D010314:Partial Thromboplastin Time; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab