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Ann Thorac Surg 2000;70:S43
© 2000 The Society of Thoracic Surgeons

Group recommendations

Jerrold H. Levy, MD, Peter K. Smith, MD, Leroy A. LeNarz, MD, John H. Lemmer, Jr, MD, Steven R. Steinhubl, MD, George J. Despotis, MD, Lawrence T. Goodnough, MD

Presented at the "Managing the Patient Receiving Platelet Inhibitors in Cardiac Surgery" Roundtable Discussion, San Antonio, TX, Jan 22–23, 1999.

The faculty who contributed to this publication recommends that the following points be considered when presented with a coronary artery bypass surgery candidate who has been treated wit hthe GP IIb/IIIa receptor inhibitor abciximab (ReoPro; Eli Lilly and Company, Indianpolis, IN).

Safety

Based on the data presented in this publication, urgent coronary bypass surgery can be safely performed on patients who have received abciximab.

Bleeding

Although the relative risk of abciximab-related bleeding may be increased if abciximab has been administered within the preceding 12 hours, this should not preclude urgent coronary revascularization when indicated. Platelets may be needed and should be available when operating on abciximab-treated patients.

Heparin dosing

There are currently no clinical or hematologic data to support reductions in heparin dosing during cardiopulmonary bypass for patients who have been treated with abciximab. Therefore, standard loading doses are recommended with additional heparin doses, based on time and duration of bypass or on actual heparin levels because activated clotting time values may be prolonged by abciximab independent of heparin during the procedure.

Platelets

The transfusion of platelets appears to effectively reverse the effect of abciximab, and therefore platelets should be available for abciximab-treated patients requiring urgent surgery. It is recommended that patients should not receive prophylactic platelet transfusion before surgery or after cardiopulmonary bypass. Rather, platelets should be administered after discontinuation of extracorporeal circulation and heparin neutralization in the setting of excessive bleeding or severe platelet inhibition as detected using platelet function tests.


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Discussion
Ann. Thorac. Surg. 2000 70: S42. [Extract] [Full Text] [PDF]




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