[en] This document presents a professional view of evidence-based recommendations around the issues of antiplatelet and anticoagulation management in cardiac surgery. It was prepared by the Audit and Guidelines Committee of the European Association for Cardio-Thoracic Surgery (EACTS). We review the following topics: evidence for aspirin, clopidogrel and warfarin cessation prior to cardiac surgery; perioperative interventions to reduce bleeding including the use of aprotinin and tranexamic acid; the use of thromboelastography to guide blood product usage; protamine reversal of heparin; the use of factor VIIa to control severe bleeding; anticoagulation after mechanical, tissue valve replacement and mitral valve repair; the use of antiplatelets and clopidogrel after cardiac surgery to improve graft patency and reduce thromboembolic complications and thromboprophylaxis in the postoperative period. This guideline is subject to continuous informal review, and when new evidence becomes available. The formal review date will be at 5 years from publication (September 2013).
Disciplines :
Surgery Cardiovascular & respiratory systems
Author, co-author :
Dunning, Joel
Versteegh, Michel
Fabbri, Alessandro
Pavie, Alain
Kolh, Philippe ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Service de biochimie et de physiologie générales, humaines et pathologiques
Lockowandt, Ulf
Nashef, Samer A M
Language :
English
Title :
Guideline on antiplatelet and anticoagulation management in cardiac surgery.
Keogh BE, Kinsman R. Fifth National Audit Cardiac Surgical Database Report. The Society of Cardiothoracic Surgeons of Great Britain and Ireland, Published by Dendrite Clinical Systems Ltd.; 2003.
Graves E.J. National hospital discharge survey: annual summary, 1991. Vital Health Stat 13 (1993) 1-62
Department of Health. Update on precautions to protect blood supply. Department of Health Publications and Statistics 2004; Reference number: 2004/0270.
Vaughan P., and Waterworth P.D. An audit of anticoagulation practice among UK cardiothoracic consultant surgeons following valve replacement/repair. J Heart Valve Dis 14 5 (2005) 576-582
Butchart E.G., Gohlke-Barwolf C., Antunes M.J., Tornos P., De Caterina R., Cormier B., Prendergast B., Lung B., Bjornstad H., Leport C., Hall R.J., Vahanian A., Working Groups on Valvular Heart Disease, Thrombosis, and Cardiac Rehabilitation and Exercise Physiology, and European Society of Cardiology. Recommendations for the management of patients after heart valve surgery. Eur Heart J 26 (2005) 2463-2471
Vahanian A., Baumgartner H., Bax J., Butchart E.G., Dion R., Filippatos G., Flachskampf F., Lung B., Kasprzak J., Nataf P., Tornao P., Torracca L., and Wenink A. Guidelines on the management of valvular heart disease: the Task Force on the Management of Valvular Heart Disease of The European Society of Cardiology. Eur Heart J 28 (2007) 230-269
Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris V.A., Ferraris S.P., Saha S.P., Hessel E.A., Haan C.K., Royston B.D., Bridges C.R., Higgins R.S., Despotis G., Brown J.R., Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion, Spiess B.D., Shore-Lesserson L., Stafford-Smith M., Mazer C.D., nett-Guerrero E., Hill S.E., and Body S. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 83 5 Suppl. (2007) S27-S86
Dunning J., Prendergast B., and Mackway-Jones K. Towards evidence-based medicine in cardiothoracic surgery: best BETS. Interact Cardiovasc Thorac Surg 2 (2003) 405-409
Strauss S.E., Richardson W.S., Glasziou P., and Haynes R.B. Evidence-based medicine: how to practice and teach EBM. 3rd ed. (2005), Churchill Livingstone, Edinburgh
Kunadian B., Thornley A.R., Tanos M., and Dunning J. Should Clopidogrel be stopped prior to urgent cardiac surgery?. Interact Cardiovasc Thorac Surg 5 (2006) 630-636
Purkayastha S., Athanasiou T., Malinovski V., Tekkis P., Foale R., Casula R., Glenville B., and Darzi A. Does clopidogrel affect outcome after coronary artery bypass grafting? A meta-analysis. Heart 92 4 (2006) 531-532
Kapetanakis E.I., Medlam D.A., Petro K.R., Haile E., Hill P.C., Dullum M.K., Bafi A.S., Boyce S.W., and Corso P.J. Effect of clopidogrel premedication in off-pump cardiac surgery: are we forfeiting the benefits of reduced hemorrhagic sequelae?. Circulation 113 13 (2006) 1667-1674
Kapetanakis E.I., Medlam D.A., Boyce S.W., Haile E., Hill P.C., Dullum M.K., Bafi A.S., Petro K.R., and Corso P.J. Clopidogrel administration prior to coronary artery bypass grafting surgery: the cardiologist's panacea or the surgeon's headache?. Eur Heart J 26 6 (2005) 576-583
Yende S., and Wunderink R.G. Effect of clopidogrel on bleeding after coronary artery bypass surgery. Crit Care Med 29 12 (2001) 2271-2275
Hongo R.H., Ley J., Dick S.E., and Yee R.R. The effect of clopidogrel in combination with aspirin when given before coronary artery bypass grafting. J Am Coll Cardiol 40 2 (2002) 231-237
Englberger L., Faeh B., Berdat P.A., Eberli F., Meier B., and Carrel T. Impact of clopidogrel in coronary artery bypass grafting. Eur J Cardiothorac Surg 26 1 (2004) 96-101
Leong J.Y., Baker R.A., Shah P.J., Cherian V.K., and Knight J.L. Clopidogrel and bleeding after coronary artery bypass graft surgery. Ann Thorac Surg 80 3 (2005) 928-933
Ascione R., Ghosh A., Rogers C., Cohen A., Monk C., and Angelini G.D. In hospital patients exposed to clopidogrel before coronary artery bypass graft surgery: a word of caution. Ann Thorac Surg 79 (2005) 1210-1216
Karabulut H., Toraman F., Evrenkaya S., Goksel O., Tarcan S., and Alhan C. Clopidogrel does not increase bleeding and allogeneic blood transfusion in coronary artery surgery. Eur J Cardiothorac Surg 25 3 (2004) 419-423
Fox K.A., Mehta S.R., Peters R., Zhao F., Lakkis N., Gersh B.J., and Yusuf S. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome: the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) Trial. Circulation 110 10 (2004) 1202-1208
Steinhubl S.R., Berger P.B., Mann III J.T., Fry E.T., DeLago A., Wilmer C., and Topol E.J. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 288 19 (2002) 2411-2420
Sabatine M.S., Cannon C.P., Gibson C.M., Lopez-Sendon J., Montalescot G., Theroux P., Claeys M.J., Cools F., Hill K.A., Skene A.M., McCabe C.H., and Braunwald E. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 352 12 (2005) 1179-1189
Braunwald E., Antman E.M., Beasley J.W., Califf R.M., Cheitlin M.D., Hochman J.S., Jones R.H., Kereiakes D., Kupersmith J., Levin T.N., Pepine C.J., Schaeffer J.W., Smith III E.E., Steward D.E., Theroux P., Gibbons R.J., Alpert J.S., Faxon D.P., Fuster V., Gregoratos G., Hiratzka L.F., Jacobs A.K., Smith Jr. S.C., and American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation 106 14 (2002) 1893-1900
Mehta S.R., Yusuf S., Peters R., Bertrand M.E., Lewis B.S., Natarajan M.K., Malmberg K., Rupprecht H.-J., Zhao F., Chrolavicius S., Copland I., and Fox K.A. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 358 (2001) 527-533
Bonow R.O., Carabello B., de Leon A.C., Edmunds Jr. L.H., Fedderly B.J., Freed M.D., Gaasch W.H., McKay C.R., Nishimura R.A., O'Gara P.T., O'Rourke R.A., Rahimtoola S.H., Ritchie J.L., Cheitlin M.D., Eagle K.A., Gardner T.J., Garson Jr. A., Gibbons R.J., Russell R.O., Ryan T.J., and Smith Jr. S.C. ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). J Heart Valve Dis 7 6 (1998) 672-707
Bonow R.O., Carabello B.A., Kanu C., de Jr. L.A., Faxon D.P., Freed M.D., Gaasch W.H., Lytle B.W., Nishimura R.A., O'Gara P.T., O'Rourke R.A., Otto C.M., Shah P.M., Shanewise J.S., Smith Jr. S.C., Jacobs A.K., Adams C.D., Anderson J.L., Antman E.M., Faxon D.P., Fuster V., Halperin J.L., Hiratzka L.F., Hunt S.A., Lytle B.W., Nishimura R., Page R.L., Riegel B., ACC/AHA Task Force, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography, Interventions, and Society of Thoracic Surgeons. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 114 5 (2006) e84-e231
Baglin T.P., Keeling D.M., Watson H.G., and For the British Committee for Standards in Haematology. Guidelines on oral anticoagulation (warfarin): third edition 2005 update. British Society for Haematology 132 (2005) 277-285
British Society of Haematologists. Guidelines on oral anticoagulation: third edition. British Journal of Haematology 101 374 (1998) 387
Salem D.N., Stein P.D., Al-Ahmad A., Bussey H.I., Horstkotte D., Miller N., and Pauker S.G. Antithrombotic therapy in valvular heart disease-native and prosthetic: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126 3 Suppl. (2004) 457S-482S
Eagle K.A., Guyton R.A., Davidoff R., Edwards F.H., Ewy G.A., Gardner T.J., Hart J.C., Herrmann H.C., Hillis L.D., Hutter Jr. A.M., Lytle B.W., Marlow R.A., Nugent W.C., Orszulak T.A., Antman E.M., Smith Jr. S.C., Alpert J.S., Anderson J.L., Faxon D.P., Fuster V., Gibbons R.J., Gregoratos G., Halperin J.L., Hiratzka L.F., Hunt S.A., Jacobs A.K., Ornato J.P., American College of Cardiology/American Heart Association Task Force on Practice Guidelines Committee to Update the, American Society for Thoracic Surgery, and Society of Thoracic Surgeons. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol 44 5 (2004) e213-e310
Sethi G.K., Copeland J.G., Goldman S., Moritz T., Zadina K., and Henderson W.G. Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting: Department of Veterans Affairs Cooperative Study on Antiplatelet Therapy. J Am Coll Cardiol 15 (1990) 15-20
Kalkat M., Levine A., and Dunning J. Does use of aprotinin in coronary artery bypass graft surgery affect graft patency?. Interact Cardiovasc Thorac Surg 1 1 (2004) 124-128
Brown J.R., Birkmeyer J.D., and O'Connor G.T. Meta-analysis comparing the effectiveness and adverse outcomes of antifibrinolytic agents in cardiac surgery. Circulation 115 (2007) 2801-2813
Mangano D.T., Tudor I.C., and Dietzel C. The risk associated with aprotinin in cardiac surgery. N Engl J Med 354 (2006) 353-365
Mangano D.T., Miao Y., Vuylsteke A., Tudor I.C., Juneja R., Filioescu D., Hoeft A., Fontes M.L., Hillel Z., Ott E., Titov T., Dietzel C., and Levin J. Mortality associated with aprotinin during 5 years following coronary artery bypass graft surgery. JAMA 297 5 (2007) 471-479
International Standard Randomised Controlled Trial Number Register: registered number. ISRCTN15166455 2007.
U.S. Food and Drugs Administration Department of Health and Human Sciences. Early communication about an ongoing safety review aprotinin injection (marketed as Trasylol). Issued November 5, 2007.
Alderman E.L., Levy J.H., Rich J.B., Nili M., Vidne B., Schaff H., Uretzky G., Pettersson G., Thiis J.J., Hantler C.B., Chaitman B., and Nadel A. Analyses of coronary graft patency after aprotinin use: results from the International Multicenter Aprotinin Graft Patency Experience (IMAGE) trial. J Thorac Cardiovasc Surg 116 5 (1998) 716-730
Laub G.W., Riebman J.B., Chen C., Adkins M.S., Anderson W.A., Fernandez J., and McGrath L.B. The impact of aprotinin on coronary artery bypass graft patency. Chest 106 5 (1994) 1370-1375
Lemmer Jr. J.H., Stanford W., Bonney S.L., Breen J.F., Chomka E.V., Eldredge W.J., Holt W.W., Karp R.B., Laub G.W., and Lipton M.J. Aprotinin for coronary bypass operations: efficacy, safety, and influence on early saphenous vein graft patency. A multicenter, randomized, double-blind, placebo-controlled study. J Thorac Cardiovasc Surg 107 2 (1994) 543-551
Bidstrup B.P., Underwood S.R., Sapsford R.N., and Streets E.M. Effect of aprotinin (Trasylol) on aorta-coronary bypass graft patency. J Thorac Cardiovasc Surg 105 1 (1993) 147-152
van der Meer J., Hillege H.L., Ascoop C.A., Dunselman P.H., Mulder B.J., van Ommen G.V., Pfisterer M., van Gilst W.H., and Lie K.I. Aprotinin in aortocoronary bypass surgery: increased risk of vein-graft occlusion and myocardial infarction? Supportive evidence from a retrospective study. Thromb Haemost 75 1 (1996) 1-3
Henry DA, Moxey AJ, Carless PA, O'Connell D, McClelland B, Henderson KM, Sly K, Laupacis A, Fergusson D. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2003 (1).
Brown JR, Birkmeyer NJ, O'Connor GT. Aprotinin in cardiac surgery. N Engl J Med 354(18):1953-7.
Munoz J.J., Birkmeyer N.J., Birkmeyer J.D., O'Connor G.T., and Dacey L.J. Is epsilon-aminocaproic acid as effective as aprotinin in reducing bleeding with cardiac surgery? A meta-analysis. Circulation 99 (1999) 81-89
Mannucci P.M., and Levi M. Prevention and treatment of major blood loss. New Engl J Med 356 22 (2007) 2301-2311
Thiagarajamurthy S., Levine A., and Dunning J. Does prophylactic tranexamic acid safely reduce bleeding without increasing thrombotic complications in patients undergoing cardiac surgery?. Interact Cardiovasc Thorac Surg 3 (2004) 489-494
Fremes S.E., Wong B.I., Lee E., Mai R., Christakis G.T., McLean R.F., Goldman B.S., and Naylor C.D. Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding. Ann Thorac Surg 58 6 (1994) 1580-1588
Ovrum E., Am H.E., Abdelnoor M., Oystese R., and Ringdal M.L. Tranexamic acid (Cyklokapron) is not necessary to reduce blood loss after coronary artery bypass operations. J Thorac Cardiovasc Surg 105 1 (1993) 78-83
Casati V., Gerli C., Franco A., Torri G., D'Angelo A., Benussi S., and Alfieri O. Tranexamic acid in off-pump coronary surgery: a preliminary, randomized, double-blind, placebo-controlled study. Ann Thorac Surg 72 2 (2001) 470-475
Hanif M., Nourei S.M., and Dunning J. Does the use of topical tranexamic acid in cardiac surgery reduce the incidence of post-operative mediastinal bleeding?. Interact Cardiovasc Thorac Surg 4 (2004) 603-605
Baric D., Unic D., Rudez I., Sef D., Ivkovic M., Brkic K., and Suttlic Z.B.B. Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind prospective, randomised study. 5th EACTS/ESTS joint meeting content of scientific sessions 201-O. Interact Cardiovasc Thorac Surg 5 (2006) S1-S175
Abdul-Azm A., and Abdullah K.M. Effect of topical tranexamic acid in open heart surgery. Eur J Anaesthesiol 23 5 (2006) 380-384
Yasim A., Aik R., and Atahan E. Effects of topical applications of aprotinin and tranexamic acid on blood loss after open heart surgery. Anadolu Kardiyoloji Dergisi 5 1 (2005) 36-40
De Bonis M., Cavaliere F., Alessandrini F., Lapenna E., Santarelli F., Moscato U., Schivello R., and Possati G.F. Topical use of tranexamic acid in coronary artery bypass operations: a double-blind, prospective, randomized, placebo-controlled study. J Thorac Cardiovasc Surg 119 (2000) 575-580
Aziz K.A.A., Masood O., Hoschtitzky A., and Ronald A. Does use of the Hepcon point-of-care coagulation monitor to optimise heparin and protamine dosage for cardiopulmonary bypass decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery?. Interact Cardiovasc Thorac Surg 5 (2006) 469-482
Raymond P.D., Ray M.J., Callen S.N., and Marsh N.A. Heparin monitoring during cardiac surgery. Part 1: validation of whole blood heparin concentration and activated clotting time. Perfusion 18 (2003) 269-276
Murray D.J., Brosnahan W.J., Pennell B., Kapalanski D., Weiler J.M., and Olson J. Heparin detection by the activated coagulation time: a comparison of the sensitivity of coagulation tests and heparin assays. J Cardiothorac Vasc Anesth 11 (1997) 24-28
Yamanishi H., Watanabe S., Hayashi K., Tomioka H., Minami M., Nozaki Y., Aoki T., Kawai Y., Kishino K., and Ohta S. A clinical evaluation of the Hepcon/HMS: a new device of monitoring hemostasis management during cardiopulmonary bypass. Kyobu Geka-Jpn J Thorac Surg 50 (1997) 459-462
Shigeta O., Kojima H., Hiramatsu Y., Jikuya T., Terada Y., Atsumi N., Sakakibara Y., Nagasawa T., and Mitsui T. Low-dose protamine based on heparin-protamine titration method reduces platelet dysfunction after cardiopulmonary bypass. J Thorac Cardiovasc Surg 118 (1999) 354-360
Despotis G.J., Joist J.H., Hogue Jr. C.W., Alsoufiev A., Kater K., Goodnough L.T., Santoro S.A., Spitznagel E., Rosenblum M., and Lappas D.G. The impact of heparin concentration and activated clotting time monitoring on blood conservation. A prospective, randomized evaluation in patients undergoing cardiac operation. J Thorac Cardiovasc Surg 110 (1995) 46-54
Despotis G.J., Joist J.H., Hogue Jr. C.W., Alsoufiev A., Joiner-Maier D., Santoro S.A., Spitznagel E., Weitz J.I., and Goodnough L.T. More effective suppression of hemostatic system activation in patients undergoing cardiac surgery by heparin dosing based on heparin blood concentrations rather than ACT. Thromb Haemost 76 (1996) 902-908
Newsome J., Stipanovich K., and Flaherty S. Comparison of heparin administration using the Rapidpoint Coag and Hepcon HMS. J Extra-Corporeal Technol 36 (2004) 139-144
Sakurada T., Kikuchi Y., Koushima R., Nakashima S., Hachiro Y., and Kagaya H. Clinical evaluation of heparin concentration and activated clotting time monitoring (HEPCON HMS) system. Nippon Kyobu Geka Gakkai Zasshi-J Jpn Assoc Thorac Surg 45 (1997) 836-840
Beholz S., Grubitzsch H., Bergmann B., Wollert H.-G., and Eckel L. Haemostasis management by use of the Hepcony HMS: increased bleeding without increased need for blood transfusion. Thorac Cardiovasc Surgeon 47 (1999) 322-327
Ohata T., Sawa Y., Ohtake S., Nishimura M., Chan C.J., Suzuki K., and Matsuda H. Clinical role of blood heparin level monitoring during open heart surgery. Nihon Kyobu Geka Gakkai Zasshi-Jpn J Thorac Cardiovasc Surg 47 (1999) 600-606
Koster A., Fischer T., Praus M., Haberzettl H., Kuebler W.M., Hetzer R., and Kuppe H. Hemostatic activation and inflammatory response during cardiopulmonary bypass: impact of heparin management. Anesthesiology 97 (2002) 837-841
Avidan M.S., Alcock E.L., Da Fonseca J., Ponte J., Desai J.B., Despotis G.J., and Hunt B.J. Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery. Br J Anaesth 92 (2004) 178-186
Shore-Lesserson L., Reich D.L., and DePerio M. Heparin and protamine titration do not improve haemostasis in cardiac surgical patients. Can J Anaesth 45 (1998) 10-18
Ronald A., and Dunning J. Can the use of thromboelastography predict and decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery?. Interact Cardiovasc Thorac Surg 1 5 (2005) 456-463
Speiss B.D., Tuman K.J., McCarthy R.J., DeLaria G.A., Schillo R., and Ivankovich A.D. Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies. J Clin Monit 3 (1987) 25-30
Ereth M.H., Nuttall G.A., Klindworth J.T., MacVeigh I., Santrach P.J., Orszulak T.A., Harmsen W.S., and Oliver W.C.J. Does the platelet-activated clotting test (HemoSTATUS) predict blood loss and platelet dysfunction associated with cardiopulmonary bypass?. Anesth Analg 85 (1997) 259-264
Essell J.H., Martin T.J., Salinas J., Thompson J.M., and Smith J.C. Comparison of thromboelastography to bleeding time and standard coagulation tests in patients after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 7 (1993) 410-415
Ti L.K., Cheong K.F., and Chen F.G. Prediction of excessive bleeding after coronary artery bypass graft surgery: the influence of timing and heparinase on thromboelastography. J Cardiothorac Vasc Anesth 16 (2002) 545-550
Nuttall G.A., Oliver W.C., Ereth M.H., and Santrach P.J. Coagulation tests predict bleeding after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 11 (1997) 815-823
Dorman B.H., Spinale F.G., Bailey M.K., Kratz J.M., and Roy R.C. Identification of patients at risk for excessive blood loss during coronary artery bypass surgery: thromboelastography versus coagulation screen. Anesth Analg 76 4 (1993) 694-700
Speiss B.D., Gillies B.S., Chandler W., and Verrier E. Changes in transfusion therapy and re-exploration rate after institution of a blood management program in cardiac surgical patients. J Cardiothorac Vasc Anesth 9 (1995) 168-173
Shore-Lesserson L., Manspeizer H.E., DePerio M., Francis S., Vela-Cantos F., and Ergin M.A. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg 88 (1999) 312-319
Royston D., and Von Kier S. Reduced haemostatic factor transfusion using heparinase-modified thrombelastography during cardiopulmonary bypass. Br J Anaesth 86 (2001) 575-578
Samama C.M., and Ozier Y. Near-patient testing of haemostasis in the operating theatre: an approach to appropriate use of blood in surgery. Vox Sang 84 (2003) 251-255
Mclaughlin K.E., and Dunning J. In patients post cardiac surgery do high doses of protamine cause increased bleeding?. Interact Cardiovasc Thorac Surg 4 (2003) 424-426
Carr Jr. M.E., and Carr S.L. At high heparin concentrations, protamine concentrations which reverse heparin anticoagulant effects are insufficient to reverse heparin anti-platelet effects. Thromb Res 75 6 (1994) 617-630
Mochizuki T., Olson P.J., Szlam F., Ramsay J.G., and Levy J.H. Protamine reversal of heparin affects platelet aggregation and activated clotting time after cardiopulmonary bypass. Anesth Analg 87 4 (1998) 781-785
Butterworth J., Yonggu A.L., Prielipp R.C., Bennett J., Hammon J.W., and James R.L. Rapid disappearance of protamine in adults undergoing cardiac operation with cardiopulmonary bypass. Ann Thorac Surg 74 (2002) 1589-1595
Gundry S.R., Drongowski R.A., Klein M.D., and Coran A.G. Postoperative bleeding in cardiovascular surgery. Does heparin rebound really exist?. Am Surg 55 3 (1989) 162-165
Jobes D.R., Aitken G.L., and Shaffer G.W. Increased accuracy and precision of heparin and protamine dosing reduces blood loss and transfusion in patients undergoing primary cardiac operations. J Thorac Cardiovasc Surg 110 1 (1995) 36-45
Tanos M., and Dunning J. Is recombinant activated factor VII useful for intractable bleeding after cardiac surgery?. Interact Cardiovasc Thorac Surg 5 (2006) 493-498
Roberts H.R., Monroe III D.M., and Hoffman M. Safety profile of recombinant factor VIIa. Semin Hematol 41 1 Suppl. 1 (2004) 101-108
Levi M., Peters M., and Buller H.R. Efficacy and safety of recombinant factor VIIa for treatment of severe bleeding: a systematic review. Crit Care Med 33 4 (2005) 883-890
Boffard K.D., Riou B., Warren B., Choong P.I., Rizoli S., Rossaint R., Axelsen M., Kluger Y., and NovoSeven Trauma Study Group. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma 59 1 (2005) 8-15
Diprose P., Herbertson M.J., O'Shaughnessy D., and Gill R.S. Activated recombinant factor VII after cardiopulmonary bypass reduces allogeneic transfusion in complex non-coronary cardiac surgery: randomized double-blind placebo-controlled pilot study. Br J Anaesth 95 5 (2005) 596-602
Herbertson M. Recombinant activated factor VII in cardiac surgery. Blood Coagul Fibrinolysis 5 Suppl. 1 (2004) S31-S32
Karkouti K., Beattie W.S., Wijeysundera D.N., Yau T.M., McCluskey S.A., Ghannam M., Sutton D., van R.A., and Karski J. Recombinant factor VIIa for intractable blood loss after cardiac surgery: a propensity score-matched case-control analysis. Transfusion 45 1 (2005) 26-34
Aggarwal A., Malkovska V., Catlett J.P., and Alcorn K. Recombinant activated factor VII (rFVIIa) as salvage treatment for intractable hemorrhage. Thrombosis J 2 1 (2004) 9
von Heymann C., Redlich U., Jain U., Kastrup M., Schroeder T., Sander M., Grosse J., Ziemer S., Koscielny J., Konertz W.F., Wernecke K.D., and Spies C. Recombinant activated factor VII for refractory bleeding after cardiac surgery-a retrospective analysis of safety and efficacy. Crit Care Med 33 10 (2005) 2241-2246
Hyllner M., Houltz E., and Jeppsson A. Recombinant activated factor VII in the management of life-threatening bleeding in cardiac surgery. Eur J Cardiothorac Surg 28 2 (2005) 254-258
Bishop C.V., Renwick W.E.P., Hogan C., Haeusler M., Tuckfield A., and Tatoulis J. Recombinant activated factor VII: treating postoperative hemorrhage in cardiac surgery. Ann Thorac Surg 81 (2006) 875-879
Vanek T., Straka Z., Hrabak J., Jares M., Brucek P.J., and Votava J. Use of recombinant activated factor VII in cardiac surgery for an effective treatment of severe intractable bleeding. Jpn Heart J 45 5 (2004) 855-860
Halkos M.E., Levy J.H., Chen E., Reddy V.S., Lattouf O.M., Guyton R.A., and Song H.K. Early experience with activated recombinant factor VII for intractable hemorrhage after cardiovascular surgery. Ann Thorac Surg 79 4 (2005) 1303-1306
Al Douri M., Shafi T., Al Khudairi D., Al Bokhari E., Black L., Akinwale N., Osman M.M., Al Homaidhi A., Al Fagih M., and Borum A.R. Effect of the administration of recombinant activated factor VII (rFVIIa; NovoSeven) in the management of severe uncontrolled bleeding in patients undergoing heart valve replacement surgery. Blood Coagul Fibrinolysis 11 Suppl. 1 (2000) S121-S127
DiDomenico R.J., Massad M.G., Kpodonu J., Navarro R.A., and Geha A.S. Use of recombinant activated factor VII for bleeding following operations requiring cardiopulmonary bypass. Chest 127 5 (2005) 1828-1835
Jamieson W.R., Cartier C.P., and Allard M. Surgical management of valvular heart disease. Can J Cardiol 20 Suppl. E (2004) 7-120
Lowe G, Belch J, Burton C, Cachia P, Cook M, Cooke T, Forbes C, Greer I, Irving J, Ludlam C, McInnes G, Murray P, Sandercock P, Treasure I, Walker I, Webster J. Antithrombotic Therapy. Scottish Intercollegiate Guidelines Network Royal College of Physicians of Edinburgh. SIGN Guideline Network; 1999.
Baudet E.M., Puel V., and McBride J.T. Long-term results of valve replacement with the St. Jude Medical prosthesis. J Thorac Cardiovasc Surg 109 (1995) 858-870
Gohlke-Barwolf C., Acar J., Oakley C., Butchart E.G., Burkhardt D., Bodnar E., Hall R., Delahaye J.P., Horstkotte D., Krayenbuhl H.P., Krzeminska-Pakula M., Kremer R., and Samama M. Guidelines for the prevention of thromboembolic events in valvular heart disease. Eur Heart J 16 (1995) 1320-1330
El-Husseiny M., Salhiyyah K., Raja S.G., and Dunning J. Should warfarin be routinely prescribed for the first three months after a bioprosthetic valve replacement?. Interact Cardiovasc Thorac Surg 5 (2006) 616-623
Nowell J., Wilton E., Markus H., and Jahangiri M. Antithrombotic therapy following bioprosthetic aortic valve replacement. Eur J Cardiothorac Surg 31 (2007) 578-585
Stein P.D., Alpert J.S., Bussey H.I., Dalen J.E., and Turpie A.G. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest 119 1 Suppl. (2001) 220S-227S
Bonow R.O., Carabello B., de Jr. L.A., Edmunds Jr. L.H., Fedderly B.J., Freed M.D., Gaasch W.H., McKay C.R., Nishimura R.A., O'Gara P.T., O'Rourke R.A., Rahimtoola S.H., Ritchie J.L., Cheitlin M.D., Eagle K.A., Gardner T.J., Garson Jr. A., Gibbons R.J., Russell R.O., Ryan T.J., and Smith Jr. S.C. Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation 98 18 (1998) 1949-1984
Sundt T.M., Zehr K.J., Dearani J.A., Daly R.C., Mullany C.J., McGregor C.G., Puga F.J., Orszulak T.A., and Schaff H.V. Is early anticoagulation with warfarin necessary after bioprosthetic aortic valve replacement?. J Thorac Cardiovasc Surg 129 5 (2005) 1024-1031
Gherli T., Colli A., Fragnito C., Nicolini F., Borrello B., Saccani S., D'Amico R., and Beghi C. Comparing warfarin with aspirin after biological aortic valve replacement: a prospective study. Circulation 110 5 (2004) 496-500
Heras M., Chesebro J.H., Fuster V., Penny W.J., Grill D.E., Bailey K.R., Danielson G.K., Orszulak T.A., Pluth J.R., Puga F.J., Schaff H.V., and Larsonkeller J.J. High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol 25 5 (1995) 1111-1119
Moinuddeen K., Quin J., Shaw R., Dewar M., Tellides G., Kopf G., and Elefteriades J. Anticoagulation is unnecessary after biological aortic valve replacement. Circulation 98 19 Suppl. (1998) II95-II98
Mistiaen W., Van C.P., Muylaert P., Sys S.U., Harrisson F., and Bortier H. Thromboembolic events after aortic valve replacement in elderly patients with a Carpentier-Edwards Perimount pericardial bioprosthesis. J Thorac Cardiovasc Surg 127 4 (2004) 1166-1170
Yao H., Miyamoto T., Mukai S., Yamamura M., Tanaka H., Nakagawa T., Ryomoto M., Inai Y., Yoshioka Y., and Kaji M. Long-term results of mitral valve replacement: biological xenograft versus mechanical valves. J Artif Organs 6 (2003) 30-36
Turpie A.G., Gent M., Laupacis A., Latour Y., Gunstensen J., Basile F., Klimek M., and Hirsh J. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Engl J Med 329 8 (1993) 524-529
Ionescu M.I., Smith D.R., Hasan S.S., Chidambaram M., and Tandon A.P. Clinical durability of the pericardial xenograft valve: ten years experience with mitral replacement. Ann Thorac Surg 34 3 (1982) 265-277
Nowell J., and Jahangiri M. Antiplatelet therapy after bioprosthetic aortic valve replacement is unnecessary in patients without thromboembolic risk. Eur J Cardiothorac Surg 32 (2007) 945
Brueck M., Kramer W., Vogt P., Steinert N., Roth R., Gorlach G., Schonburg M., and Heidt M.C. Antiplatelet therapy early after bioprosthetic aortic valve replacement is unnecessary in patients without thromboembolic risk factors. Eur J Cardiothorac Surg 32 (2007) 108-112
Colli A, Verhoye J-P, Robin H, Strauch J, Matt P, Pagano D. Anticoagulation Therapy After Bioprosthetic Aortic Valve Replacement: Action Registry Survey Results. Society for Heart Valve disease: fourth biennial meeting, New York, USA; 2007. p. 52.
Nagarajan D.V., Lewis P.S., Botha P., and Dunning J. Is addition of anti-platelet therapy to warfarin beneficial to patients with prosthetic heart valves?. Interact Cardiovasc Thorac Surg 3 (2004) 450-455
Massel D., and Little S.H. Risks and benefits of adding anti-platelet therapy to warfarin among patients with prosthetic heart valves: a meta-analysis. J Am Coll Cardiol 37 2 (2001) 569-578
Little SH, Massel D. Antiplatelet and anticoagulation for patients with prosthetic heart valves. The Cochrane Library, vol. 1, 2003.
Laffort P., Roudaut R., Roques X., Lafitte S., Deville C., Bonnet J., and Baudet E. Early and long-term (one-year) effects of the association of aspirin and oral anticoagulant on thrombi and morbidity after replacement of the mitral valve with the St. Jude medical prosthesis: a clinical and transesophageal echocardiographic study. J Am Coll Cardiol 35 3 (2000) 739-746
Meschengieser S.S., Fondevila C.G., Frontroth J., Santarelli M.T., and Lazzari M.A. Low-intensity oral anticoagulation plus low-dose aspirin versus high-intensity oral anticoagulation alone: a randomized trial in patients with mechanical prosthetic heart valves. J Thorac Cardiovasc Surg 113 5 (1997) 910-916
Asopa S., Patel A., and Dunning J. Is short term anticoagulation necessary after mitral valve repair?. Interactive J Thorac Cardiovasc Surg 5 (2006) 761-765
Jovin A., Hashim S., Jovin I.S., Clancy J.F., Klovekorn W.P., and Muller-Berghaus G. Atrial fibrillation at discharge from the hospital in patients undergoing mitral valve repair. Thorac Cardiovasc Surg 53 1 (2005) 41-45
Aramendi J.L., Agredo J., Llorente A., Larrarte C., and Pijoan J. Prevention of thromboembolism with ticlopidine shortly after valve repair or replacement with a bioprosthesis. J Heart Valve Dis 7 6 (1998) 610-614
Deloche A., Jebara V.A., Relland J.Y., Chauvaud S., Fabiani J.N., Perier P., Dreyfus G., Mihaileanu S., and Carpentier A. Valve repair with Carpentier techniques. The second decade. J Thorac Cardiovasc Surg 99 6 (1990) 990-1001
Braunberger E., Deloche A., Berrebi A., Abdallah F., Celestin J.A., Meimoun P., Chatellier G., Chauvaud S., Fabiani J.N., and Carpentier A. Very long-term results (more than 20 years) of valve repair with Carpentier's techniques in nonrheumatic mitral valve insufficiency. Circulation 104 90001 (2001) 8I-11I
Chauvaud S., Fuzellier J.F., Berrebi A., Deloche A., Fabiani J.N., and Carpentier A. Long-term (29 years) results of reconstructive surgery in rheumatic mitral valve insufficiency. Circulation 104 90001 (2001) 12I-15I
Dunning J., Treasure T., Versteegh M., and Nashef S.A.M. Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery. Eur J Cardiothorac Surg 30 (2006) 852-872
Close V., Purohit M., Tanos M., and Hunter S. Should patients post cardiac surgery be given low molecular weight heparin for deep vein thrombosis prophylaxis?. Interact Cardiovasc Thorac Surg 5 (2006) 624-629
The National Collaborating Centre for Acute Care. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery, NICE clinical guideline 46. National Institute for Health and Clinical Excellence, 71 High Holborn, London, UK, 2007.
Shammas N.W. Pulmonary embolus after coronary artery bypass surgery: a review of the literature. Clin Cardiol 23 9 (2000) 637-644
Reis S.E., Polak J.F., Hirsch D.R., Cohn L.H., Creager M.A., Donovan B.C., and Goldhaber S.Z. Frequency of deep venous thrombosis in asymptomatic patients with coronary artery bypass grafts. Am Heart J 122 2 (1991) 478-482
Josa M., Siouffi S.Y., Silverman A.B., Barsamian E.M., Khuri S.F., and Sharma G.V. Pulmonary embolism after cardiac surgery. J Am Coll Cardiol 21 4 (1993) 990-996
Goldhaber S.Z., Hirsch D.R., MacDougall R.C., Polak J.F., Creager M.A., and Cohn L.H. Prevention of venous thrombosis after coronary artery bypass surgery (a randomized trial comparing two mechanical prophylaxis strategies). Am J Cardiol 76 14 (1995) 993-996
DeLaria G.A., and Hunter J.A. Deep venous thrombosis. Implications after open heart surgery. Chest 99 2 (1991) 284-288
Wisoff B.G., Hartstein M.L., Aintablian A., and Hamby R.I. Risk of coronary surgery. Two hundred consecutive patients with no hospital deaths. J Thorac Cardiovasc Surg 69 5 (1975) 669-673
Rao G., Zikria E.A., Miller W.H., Samadani S.R., and Ford W.B. Incidence and prevention of pulmonary embolism after coronary artery surgery. Vasc Surg 9 1 (1975) 37-45
Pouplard C., May M.A., Iochmann S., Amiral J., Vissac A.M., Marchand M., and Gruel Y. Antibodies to platelet factor 4-heparin after cardiopulmonary bypass in patients anticoagulated with unfractionated heparin or a low-molecular-weight heparin: clinical implications for heparin-induced thrombocytopenia. Circulation 99 19 (1999) 2530-2536
Gillinov A.M., Davis E.A., Alberg A.J., Rykiel M., Gardner T.J., and Cameron D.E. Pulmonary embolism in the cardiac surgical patient. Ann Thorac Surg 53 6 (1992) 988-991
Ambrosetti M., Salerno M., Zambelli M., Mastropasqua F., Tramarin R., and Pedretti R.F. Deep vein thrombosis among patients entering cardiac rehabilitation after coronary artery bypass surgery. Chest 125 1 (2004) 191-196
Ramos R., Salem B.I., De Pawlikowski M.P., Coordes C., Eisenberg S., and Leidenfrost R. The efficacy of pneumatic compression stockings in the prevention of pulmonary embolism after cardiac surgery. Chest 109 1 (1996) 82-85
Geerts W.H., Heit J.A., Clagett G.P., Pineo G.F., Colwell C.W., Anderson Jr. F.A., and Wheeler H.B. Prevention of venous thromboembolism. Chest 119 1 Suppl. (2001) 132S-175S
Gutt C.N., Oniu T., Wolkener F., Mehrabi A., Mistry S., and Buchler M.W. Prophylaxis and treatment of deep vein thrombosis in general surgery. Am J Surg 89 1 (2005) 14-22
Bergqvist D. Low molecular weight heparin for the prevention of venous thromboembolism after abdominal surgery. Br J Surg 91 8 (2004) 965-974
Malouf J.F., Alam S., Gharzeddine W., and Stefadouros M.A. The role of anticoagulation in the development of pericardial effusion and late tamponade after cardiac surgery. Eur Heart J 14 11 (1993) 1451-1457
Kulik A., Rubens F.D., Wells P.S., Kearon C., Mesana T.G., van Berkom J., and Lam B.K. Early postoperative anticoagulation after mechanical valve replacement: a systematic review. Ann Thorac Surg 81 (2006) 700-781
Dunning J., and Das S. What is the optimal dose of aspirin after discharge following coronary bypass surgery. Interact Cardiovasc Thorac Surg 4 (2003) 427-430
British Cardiac Society, British Hypertension Society, Diabetes, U.K., HEART., U.K., Primary Care Cardiovascular Society, Stroke Association. JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 91 Suppl. 5 (2005) v1-v52
Fremes S.E., Levinton C., Naylor C.D., Chen E., Christakis G.T., and Goldman B.S. Optimal antithrombotic therapy following aortocoronary bypass: a meta-analysis. Eur J Cardiothorac Surg 7 4 (1993) 169-180
Mangano D.T. Aspirin and mortality from coronary bypass surgery. New Engl J Med 347 17 (2002) 1309-1317
Lim E., Ali Z., Ali A., Routledge T., Edmonds L., Altman D.G., and Large S. Indirect comparison meta-analysis of aspirin therapy after coronary surgery. Br Med J 327 (2003) 1309-1311
Gavaghan T.P., Gebski V., and Baron D.W. Immediate postoperative aspirin improves vein graft patency early and late after coronary artery bypass graft surgery: a placebo-controlled, randomized study. Circulation 83 5 (1991) 1526-1533
Goldman S., Copeland J., Moritz T., Henderson W., Zadina K., Ovitt T., Doherty J., Read R., Chesler E., and Sako Y. Saphenous vein graft patency 1 year after coronary artery bypass surgery and effects of antiplatelet therapy. Results of a Veterans Administration Cooperative Study. Circulation 80 5 (1989) 1190-1197
Lorenz R.L., Schacky C.V., Weber M., Meiter W., Kotzur J., and Reichardt B. Improved aortocoronary bypass patency by low-dose aspirin (100 mg daily). Effects on platelet aggregation and thromboxane formation). Lancet I 1261 (1984) 1264
Sanz G., Pajaron A., Alegria E., Coello I., Cardona M., Fournier J.A., Gomez-Recio M., Ruano J., Hidalgo R., and Medina A. Prevention of early aortocoronary bypass occlusion by low-dose aspirin and dipyridamole. Grupo Espanol para el Seguimiento del Injerto Coronario (GESIC). Circulation 82 3 (1990) 765-773
Hockings B.E., Ireland M.A., Gotch-Martin K.F., and Taylor R.R. Placebo-controlled trial of enteric coated aspirin in coronary bypass graft patients. Effect on graft patency. Med J Aust 159 6 (1993) 376-378
Stein P., Dalen J., Goldman S., and Theroux P. Antithrombotic therapy in patients with saphenous veins and internal mammary artery bypass grafts. Chest 119 1 (2001) 278S-282S
Stein P.D., Schunemann H.J., Dalen J.E., and Gutterman D. Antithrombotic therapy in patients with saphenous vein and internal mammary artery bypass grafts: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126 3 Suppl. (2004) 600S-608S
Musleh G., and Dunning J. Does aspirin 6 h after coronary artery bypass grafting optimise graft patency?. Interact Cardiovasc Thorac Surg 4 (2003) 413-415
Sharma G.V., Khuri S.F., Josa M., Folland E.D., and Parisi A.F. The effect of antiplatelet therapy on saphenous vein coronary artery bypass graft patency. Circulation 68 3 Pt 2 (1983) t-21
Kunadian B., Babu N., and Dunning J. Should high risk patients receive clopidogrel as well as aspirin post coronary arterial bypass grafting?. Interact Cardiovasc Thorac Surg 5 (2006) 755-760
Nagarajan D.V., Lewis P.S., and Dunning J. Is clopidogrel beneficial following coronary bypass surgery?. Interact Cardiovasc Thorac Surg 2 (2004) 311-313
Bhatt D.L., Chew D.P., Hirsch A.T., Ringleb P.A., Hacke W., and Topol E.J. Superiority of clopidogrel versus aspirin in patients with prior cardiac surgery. Circulation 103 3 (2001) 363-368
Yusuf S., Zhao F., Mehta S.R., Chrolavicius S., Tognoni G., and Fox K.K. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 345 7 (2001) 494-502
Saw J., Topol E.J., Steinhubl S.R., Brennan D., Berger P.B., Moliterno D.J., and CREDO Investigators. Comparison of long-term usefulness of clopidogrel therapy after the first percutaneous coronary intervention or coronary artery bypass grafting versus that after the second or repeat intervention. Am J Cardiol 94 5 (2004) 623-625
Gurbuz A.T., Zia A.A., Vuran A.C., Cui H., and Aytac A. Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery: a prospective study. Eur J Cardiothorac Surg 29 2 (2006) 190-195
Kulik A., Le May M., Wells G.A., Mesana T.G., and Ruel M. The clopidogrel after surgery for coronary artery disease (CASCADE) randomized controlled trial: clopidogrel and aspirin versus aspirin alone after coronary bypass surgery. Curr Control Trials Cardiovasc Med 6 15 (2005) [NCT00228423]
Popma J.J., Berger P., Ohman E.M., Harrington R.A., Grines C., and Weitz J.I. Antithrombotic therapy during percutaneous coronary intervention: Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126 (2004) 576-599
Kaluza G.L., Joseph J., Lee J.R., Raizner M.E., and Raizner A.E. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol 35 5 (2000) 1288-1294