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Ann Thorac Surg 2001;71:1748-1749
© 2001 The Society of Thoracic Surgeons

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Correspondence

Antithrombotic treatment in patients with unstable coronary artery disease undergoing CABG: Reply

^a The Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, United Kingdom

To the Editor

We were delighted to receive the comments of Dr Stahle and Dr Lindahl regarding our research on the increased risk of bleeding in patients with unstable angina receiving low–molecular-weight heparins within 12 hours of their operation. Their comments are particularly welcome as they were participants in the FRISC II study. We entirely agree with their comments that it is only a few patients who are awaiting revascularization who experience significant recurrent myocardial ischaemia in the preoperative period if their anticoagulant therapy is discontinued. Those patients who do have recurrent angina, having stopped anticoagulation, would normally proceed to urgent surgery under normal circumstances at our institution. We were fascinated to see that 26 patients received low–molecular-weight heparin in the FRISC II study within 12 hours of their coronary artery bypass surgery for clinical reasons. Although the FRISC II experimental protocol required that the last injection of anticoagulant be given no later than 12 hours before revascularization it is clear that this number of patients represents a tiny proportion of the total number undergoing surgery in this study. In 11.5% of these patients bleeding was reported and two-thirds of the cases needed to return to the theater for further hemostasis. This data is clearly very crude and, in our study [1], we were able to look at the blood loss in the postoperative period in much greater detail. Although more mediastinal chest tube losses were noted in patients receiving low molecular weight heparin within 12 hours of operation, we did not demonstrate an increase in the reopening rate. We did note, however, that the need for blood transfusion and the use of related blood products was higher in this cohort of patients. Sadly, Dr Stahle is unable to provide these data, but it would indeed be interesting to examine the effects of dalteparin in the 26 patients described in greater depth. It remains the case that early surgery for unstable angina consistently provides patients with a better outcome than medical therapy. There is no question that careful and meticulous surgical hemostasis is the most important defense against unacceptable blood loss after surgery in this important group of patients.

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1. Clark SC, Vitale N, Zacharias J, Forty J. Effect of low molecular weight heparin (Fragmin) on bleeding after cardiac surgery Ann Thorac Surg 2000;69:762-765.[Abstract/Free Full Text]

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				S.E. Husted, L. Wallentin, B. Lagerqvist, F. Kontny, E. Stahle, and E. Swahn Benefits of extended treatment with dalteparin in patients with unstable coronary artery disease eligible for revascularization Eur. Heart J., August 1, 2002; 23(15): 1213 - 1218. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen C Clark Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Clark, S. C. Search for Related Content PubMed PubMed Citation Articles by Clark, S. C.