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Correspondence

Reply

Department of Cardiac Surgery, University Hospital Grosshadern, Marchioninistrasse 15, Munich, 81377 Germany

(Email: andres.beiras{at}med.uni-muenchen.de).

To the Editor:

We appreciate very much the interest expressed by Bizzarri and Frati [1] regarding our brief communication about a case of profound thrombocytopenia after off-pump coronary artery bypass grafting and treatment with tirofiban [2]. We agree with the authors that preoperative treatment with glycoprotein IIb/IIIa antagonists may be challenging due to postoperative bleeding complications. In fact, the aim of our report was to underline the risk of thrombocytopenia after infusion of these molecules, as well as to suggest management strategies to deal with this complication. Bizzarri and Frati [1] raised an important issue in the preoperative use of tirofiban for patients undergoing coronary artery bypass grafting (ie, the use of extracorporeal circulation). In a previous work, they showed no adverse clinical effects of tirofiban in patients undergoing on-pump coronary artery bypass grafting [3]. Although the use of cardiopulmonary bypass might reduce the effect of tirofiban through conformational changes of the thrombocytes, or through direct filtration of these molecules, it is not clear whether tirofiban may exert a protective effect on platelets.

In our opinion, more data regarding the use of tirofiban in patients undergoing off-pump coronary surgery should be collected to answer the paradoxical question of Bizzarri and Frati [1]. However, we agree with the authors that the administration of tirofiban should be stopped early and preoperatively to reduce the bleeding risks. Further studies are needed to investigate the association between profound thrombocytopenia and GP IIb/IIIa antagonists.

	References

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1. Bizzarri F, Frati G. Acute profound thrombocytopenia after treatment with tirofiban and off-pump coronary artery bypass grafting: is there a paradox? (letter) Ann Thorac Surg 2009;88:1048.[Free Full Text]
2. Beiras-Fernandez A, Kowert A, Jiru P, et al. Acute profound thrombocytopenia after treatment with tirofiban and off-pump coronary artery bypass grafting Ann Thorac Surg 2009;87:629-631.[Abstract/Free Full Text]
3. Bizzarri F, Scolletta S, Tucci E, et al. Perioperative use of tirofiban hydrocloride (Aggrastat) does not increase surgical bleeding after emergency or urgent coronary artery bypass grafting J Thorac Cardiovasc Surg 2001;122:1181-1185.[Abstract/Free Full Text]

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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Andres Beiras-Fernandez Michael Schmoeckel Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Beiras-Fernandez, A. Articles by Schmoeckel, M. Search for Related Content PubMed Articles by Beiras-Fernandez, A. Articles by Schmoeckel, M. Related Collections Related Article