Pulmonary Embolism After Coronary Artery Bypass Grafting

Goldhaber, Samuel Z.; Schoepf, U. Joseph

doi:10.1161/01.cir.0000132616.89315.34

Cited by 29 publications

(26 citation statements)

References 19 publications

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“…Of note, several reviews on the subject have proposed that new clinical trials should be performed to identify the optimal approach for post-CABG VTE prevention. 1,4,30 Given the low event rate, however, we believe it will be difficult if not impossible to conduct adequately powered trials to prospectively compare different VTE prevention strategies after CABG.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Preventative Therapy for Venous Thromboembolism After Coronary Artery Bypass Graft Surgery

Kulik

Rassen

Myers

et al. 2012

Circ: Cardiovascular Interventions

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Background-Controversy exists regarding the optimal preventative therapy for venous thromboembolism (VTE) after coronary artery bypass graft (CABG) surgery. We sought to compare the effectiveness and safety of the most commonly used regimens. Methods and Results-We assembled a cohort of 92 699 patients who underwent CABG between 2004 and 2008, using the Premier database. Patients were categorized by method of VTE prevention initiated within 48 hours of surgery, including no preventative therapy (n=55 400), mechanical preventative therapy (n=21 162), subcutaneous unfractionated or low-molecular-weight heparin (n=10 718), subcutaneous fondaparinux (n=88), and concurrent mechanicalchemical therapy (n=5331). The incidence of VTE and major bleeding events within 6 weeks of CABG were compared, using multivariable and propensity score adjustment. The overall incidence of VTE for the entire cohort was 0.74%, and the incidence of major bleeding was 1.43%. VTE and bleeding events occurred with similar incidence in each of the patient categories (VTE: 0.70%, 0.79%, 0.81%, 1.14%, and 0.73%; major bleeding: 1.36%, 1.45%, 1.69%, 3.41%, 1.50%; no prevention, mechanical prevention, subcutaneous heparin, subcutaneous fondaparinux, concurrent mechanical-chemical prevention, respectively). Compared with receiving no prevention, the use of mechanical prevention or subcutaneous heparin did not significantly reduce the risk of VTE or change the risk of major bleeding (P=NS). Conclusions-Venous thromboembolism occurs infrequently after CABG. Compared with the use of no prevention, the administration of chemical or mechanical preventative therapies to CABG patients does not appreciably lower the risk of VTE. These data provide support for the common practice of administering no VTE preventative therapy after CABG, used for nearly 60% of patients within this cohort. (Circ Cardiovasc Interv. 2012;5:590-596.)

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Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Preventative Therapy for Venous Thromboembolism After Coronary Artery Bypass Graft Surgery

Kulik

Rassen

Myers

et al. 2012

Circ: Cardiovascular Interventions

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“…It is estimated, based on extrapolated data, that 1,100 -1,300 deaths occur in the United States each year as a result of VTE after coronary artery bypass grafting. 27 Although asymptomatic VTE occurs frequently, 28 symptomatic VTE can also go undetected after cardiac surgery, because symptoms-such as shortness of breath and leg discomfort or swelling-may be attributed to the expected consequences of the preexisting conditions or surgery (i.e., saphenous vein harvest). 27 The overall risk of clinically important VTE may be relatively low after coronary artery bypass grafting, but patients often require anticoagulation because of unstable angina or the presence of other risk factors.…”

Section: Vte After Surgerymentioning

confidence: 99%

“…27 Although asymptomatic VTE occurs frequently, 28 symptomatic VTE can also go undetected after cardiac surgery, because symptoms-such as shortness of breath and leg discomfort or swelling-may be attributed to the expected consequences of the preexisting conditions or surgery (i.e., saphenous vein harvest). 27 The overall risk of clinically important VTE may be relatively low after coronary artery bypass grafting, but patients often require anticoagulation because of unstable angina or the presence of other risk factors. 12 Despite limited evidence, the ACCP recommends thromboprophylaxis with LMWH, UFH, or optimally used bilateral intermittent pneumatic compression or graduated compression stockings, to provide early thromboprophylaxis in patients who may have a more complicated postoperative course than usual (grade 1C).…”

Section: Vte After Surgerymentioning

confidence: 99%

Novel Oral Anticoagulants

2010

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Patients undergoing surgery receive anticoagulation for perioperative thromboprophylaxis or ischemic cardiovascular disease. Because anticoagulants may also potentiate bleeding, clinicians need to understand the implications of anticoagulation in perioperative and postoperative patient management. Many newer anticoagulants that are now available or are in clinical development do not require routine coagulation monitoring, have more predictable dose responses, and have fewer interactions with other drugs and food. The most advanced oral anticoagulants in clinical development are the direct factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran etexilate. These agents have been evaluated in the postoperative setting in patients undergoing total hip-or knee-replacement surgery with promising results, and it remains to be seen whether these results will translate into other surgical settings. The impact of the new agents will be influenced by the balance between efficacy and safety, improved convenience, and potential cost-effectiveness benefits.

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“…Although the role of anticoagulation in facilitating PEF is well established after cardiac valve replacement, such role has not been definitely explored after coronary artery bypass graft (CABG) surgery. Venous thromboembolism (VTE) has been recently confirmed to be a potential complication of CABG surgery [2]. To explore the risk and the natural history of PEF in patients requiring antithrombotic therapy for deep vein thrombosis (DVT) after CABG, we carried out a prospective, observational study in a population of inpatients who underwent systematic ultrasonographic screening for postoperative DVT.…”

mentioning

confidence: 99%

“…This and the accompanying Commentary [2] and the three ÔDebateÕ articles [3][4][5] are to be commended for addressing the important and difficult question of the optimal intensity of anticoagulation for secondary …”

mentioning

confidence: 99%