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Ann Thorac Surg 1999;67:292-293
© 1999 The Society of Thoracic Surgeons
a Divisions of Cardiothoracic Surgery and Cardiovascular Medicine, Easton Hospital, 123 S 22nd St, Easton, PA 18042, USA
To the Editor
We read with interest the article by Gammie and associates [1] regarding abciximab and excessive bleeding in patients undergoing emergency cardiac operations published in the February 1998 issue of The Annals of Thoracic Surgery. Based on their initial experience, Gammie and associates concluded that abciximab, when given within 12 hours of cardiac operation, is associated with significantly increased blood loss and transfusion requirements.
We recently reviewed our experience with patients who underwent emergency coronary artery bypass grafting (CABG) after receiving abciximab. We retrospectively collected data on 4 patients who underwent emergency CABG after failed percutaneous transluminal coronary angioplasty (PTCA). Abciximab was administered to all 4 patients. They all received aspirin and underwent heparinization with the aim of maintaining the activated clotting time between 200 and 300 seconds. In our patients, the mean maximum activated clotting time was 339 seconds (range, 217 to 413 seconds). Because routine platelet transfusion reduces the risk of perioperative bleeding in patients who undergo emergency CABG after receiving abciximab [2], we routinely transfused all 4 patients with platelets. The mean time interval between PTCA and CABG was 272 minutes (range, 182 to 355 minutes).
In our series, all 4 patients underwent successful revascularization. Major blood loss, defined as a greater than 5-g/dL decrease in hemoglobin, occurred in 1 patient. All the patients received a transfusion of packed red blood cells; the patient with major blood loss required 4 units, whereas the other 3 patients required 2 units each. The mean hospital stay was 7 days (range, 5 to 11 days). No patient had a complicated hospital course. All the patients are alive and active at a mean follow-up of 19 months (range, 16 to 25 months).
In our patients, emergency CABG was performed within 6 hours of abciximab administration, yet there were no substantial bleeding complications. Although our community hospital experience is limited, it points to acceptable bleeding complications in patients who undergo emergency CABG after receiving abciximab. Similar results were reported by Juergens and associates [2], who stated that the routine use of platelet transfusion to reverse the effects of abciximab in patients undergoing emergency CABG after failed angioplasty appears reasonable.
Although the risk of bleeding associated with abciximab administration in patients undergoing emergency CABG is still a concern, several strategies to enhance the safety of abciximab have emerged [3]. Of significant importance are the use of low-dose adjunctive heparin [4] and prophylactic platelet transfusion en route to the operating room or at the time of operation [2].
References
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