THE INFLUENCE OF ANTIPLATELET MEDICATIONS ON INTRAOPERATIVE PATIENT BLOOD MANAGEMENT DURING ADULT CARDIAC SURGERY

Abstract

Introduction Cardiac surgery is inherently associated with increased bleeding and transfusion requirements. The increased risk of bleeding is due to multiple factors; pharmacological (Intravenous heparin and Dual Antiplatelet Therapy-DAPT), patient (advanced age, preoperative anaemia, and female gender) and surgical (Emergency and redo surgery)1. This study aimed to determine if preoperative antiplatelet medication influenced intraoperative blood and blood products requirements during elective adult Isolated Coronary Artery Bypass Graft (CABG) and valve surgery. Methods Methodology: A Prospective observational study carried out between September to November 2020, MMUH Ethical committee approval ref: CA20-064 on 12/10/2020. Perioperative data were collected from fifty patients. This included demographic data, preoperative laboratories, pre-Cardiopulmonary Bypass (CPB) heparin dose, Activated Clotting Time (ACT) at baseline, post heparin and post protamine, blood products transfused and estimated blood loss (EBL). The inclusion criteria applied was isolated CABG, single valve surgery and elective operation. A one-paired Student t-test performed to detect a statistical difference between the two groups (Isolated CABG Vs Single valve Surgery) Results 31 patients met the inclusion criteria. 19 patients excluded because of the following reasons: emergency surgery n=3, redo surgery n=1, New Oral Anticoagulants (NOACS) medication n= 4, combined CABG & valve surgery/other n=12. 20 patients underwent an isolated CABG, and 11 patients underwent a single valve operation. DAPT was prescribed in 30% n=6/20 and 9% n=1/11 in the CABG and Valve group respectively. There was no statistical difference in the EBL at the end of the procedure between the two groups (CABG-624 ml Vs Valve-507 ml, p= 0.13). Intraoperative red cells transfusion between the two groups were similar, however Octaplasma, fibrinogen and platelets transfusion were higher in the valve group. Discussion DAPT were more frequently prescribed pre-operatively in patients undergoing elective CABG in comparison to single valve surgery. Pre & postoperative haemoglobin and EBL were similar between the two groups. Despite this, in the single valve surgery group (only 1 patient out of 9 received DAPT, n=1/9) received more blood products during the intraoperative period. This was statistically significant for the use of Octaplasma, Platelets and fibrinogen. Blood transfusion was not directed using ROTEM in any patients in either group. We, therefore, recommend the intraoperative use of ROTEM to guide blood transfusion for patients undergoing isolated single valve surgery.