title: Different anticoagulation strategies in off-pump coronary artery bypass operations: a European survey.
abstract: In order to determine anticoagulation strategies in OPCAB a questionnaire survey among 750 European cardio-thoracic surgeons was performed. Questions addressed volume of OPCAB procedures performed, intra- and perioperative heparinization and antiplatelet therapy, as well as perioperative management. A total of 325 (43.7%) questionnaires were returned and validated. Perioperative protocols for administration of antiplatelets differed among the respondent surgeons. Perioperative prophylaxis of thrombosis (low or high molecular weight heparin) is performed by 78%. Intraoperative heparin dosage range between 70 U/kg to 500 U/kg, 60% of respondents prefer a low-dose regimen (< or = 150 U/kg). Correspondingly, the lowest activated clotting time (ACT) during surgery is accepted to be 200 s by 24%, 250 s by 18% and 300 s by 26% of surgeons. Protamine is used by 91% of respondents, while 52% perform a 1:1 reversal. A cell-saver and antifibrinolytics are used by 70% and 40%, respectively. Interestingly, 56% of respondents think bleeding in OPCAB patients is not reduced when compared to on-pump CABG. In addition, 34% of respondents believe there is an increased risk of early graft occlusion following OPCAB. This survey demonstrates widely different intra- and perioperative anticoagulation strategies for OPCAB procedures among European surgeons.
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University Hospital, Freiburgstrasse, 3010 Berne, Switzerland. lars.englberger@insel.ch
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.forename: Marianne
authors.initials: M
authors.lastname: Streich
authors.forename: Hendrik
authors.initials: H
authors.lastname: Tevaearai
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D004334:Drug Administration Schedule; D005060:Europe; D019538:Health Care Surveys; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011479:Protamines / Q000008:administration & dosage; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D011479:Protamines; D006493:Heparin