CABG-procedures in patients with pretreatment with the GPIIb/IIIa-receptor antagonist tirofiban (Aggrastat): modification of perioperative management?
In order to investigate the effects of tirofiban administration in cardiac surgery all patients undergoing coronary artery bypass grafting (CABG) which received this drug preoperatively between 1/2002 and 6/2005 (n=232) were studied. Three groups regarding the perioperative administration of antifibrinolytic drugs were compared: group A=controls (n=70), group B=aprotinin (n=110), group C=tranexamic acid (n=52) Furthermore we could differ the patients depending on the time when tirofiban was stopped (<2 h, 2-4 h, >4 h preoperatively). The postoperative blood loss was significantly higher in all tirofiban-patients (A-C) compared to a group of CABG-patients without tirofiban. The best results concerning blood loss, transfusion of red cell concentrates (rcc), fresh frozen plasma (ffp) and incidence of re-sternotomy could be found in patients with aprotinin. A further significant improvement could be seen in patients who received platelets, intraoperative hemofiltration and in which tirofiban was stopped >4 h preoperatively. We conclude that by early presurgical discontinuing of tirofiban-therapy and slight modifications of the perioperative management bleeding complications can significantly be reduced.
Boeken
U
U
Litmathe
J
J
Kurt
M
M
Feindt
P
P
Gams
E
E
D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D007611:Aprotinin / Q000008:administration & dosage; D001026:Coronary Artery Bypass; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011300:Preoperative Care; D012189:Retrospective Studies; D000077466:Tirofiban; D014148:Tranexamic Acid / Q000008:administration & dosage; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D000933:Antifibrinolytic Agents; D005343:Fibrinolytic Agents; D006490:Hemostatics; D014443:Tyrosine; D014148:Tranexamic Acid; D007611:Aprotinin; D000077466:Tirofiban