Tirofiban therapy does not increase the risk of hemorrhage after emergency coronary surgery

Genoni, Michele; Zeller, Daniela; Bertel, Osmund; Maloigne, M.; Turina, Marko

doi:10.1067/mtc.2001.115691

Cited by 18 publications

(10 citation statements)

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“…Genoni et al [25] retrospectively compared the risk of hemorrhage in patients whose tirofiban infusion was stopped at different times preceding the start of surgery. 17/40 patients had their tirofiban infusion stopped more than 8 h before surgery (mean 24 h blood loss-923C/K734 ml; Postoperative ACT-147C/K26; Post-operative platelet count-109C/K34!10 9 /l), while 23/40 had their tirofiban infusion stopped less than 8 h before surgery (mean 24 h blood lossZ 845C/K481 ml; Post-operative ACT-137C/K22; Postoperative platelet count-114C/K30!10 9 /l).…”

Section: Post-operative Bleedingmentioning

confidence: 99%

Tirofiban and emergency coronary surgery

Shanmugam

2005

European Journal of Cardio-Thoracic Surgery

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The final common pathway of platelet aggregation leading to coronary thrombosis involves cross-linking of platelet receptor glycoprotein IIb-IIIa by primarily fibrinogen. Glycoprotein IIb-IIIa antagonists are being increasingly used as adjunctive therapy during percutaneous coronary intevention, and have shown to reduce the risk of death and myocardial infarction. However, a proportion of these patients continue to remain ischemic and present for emergency coronary grafting. The profound platelet inhibition in these patients enhances the already heightened risk of post-operative bleeding. With the recent approval of tirofiban for patients with acute coronary syndromes, the number of patients receiving tirofiban who subsequently undergo coronary artery bypass grafting is expected to increase substantially. Little clinical data exist, on patients who require immediate coronary artery grafting after receiving tirofiban. This article reviews the evidence for bleeding following tirofiban, discusses the relevant mechanism of action and pharmacodynamics, and analyses the strategies available in patients who need emergency coronary artery grafting after tirofiban.

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Section: Post-operative Bleedingmentioning

confidence: 99%

Tirofiban and emergency coronary surgery

Shanmugam

2005

European Journal of Cardio-Thoracic Surgery

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“…Another retrospective cohort assessed risk of hemorrhage in 40 patients receiving tirofiban, analysed as to whether the tirofiban was stopped more than or less than 8 hours prior to surgery. 28 These authors found no differences in postoperative coagulation parameters nor did they identify a relationship between timing of tirofiban and blood loss during the first 24 hours. Given the limited and conflicting data regarding the use of tirofiban surrounding cardiovascular surgery, it is also not an ideal choice for bridging therapy.…”

Section: Tirofibanmentioning

confidence: 89%

Prolonged Infusion of Eptifibatide as Bridge Therapy Between Bare‐Metal Stent Insertion and Cardiovascular Surgery: Case Report and Review of the Literature

Pickett¹,

Taylor²,

Ackman³

2010

Pharmacotherapy

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Dual antiplatelet therapy with aspirin and clopidogrel is the standard of care after coronary artery stent insertion. Clopidogrel, however, has been associated with an increased risk of bleeding if it is used before coronary artery bypass grafting (CABG), and current guidelines recommend that it be discontinued at least 5 days before surgery. Compared with dual antiplatelet therapy, single antiplatelet therapy or the combination of an antiplatelet agent and an anticoagulant is associated with an increased risk of subacute stent thrombosis. Management of patients who require semiurgent CABG after stent insertion presents a clinical challenge. Intravenous glycoprotein IIb-IIIa inhibitors provide antiplatelet coverage with a shorter duration of action; thus, in theory, they may be useful for these clinical situations. We describe a 47-year-old man who came to the emergency department with sudden-onset, retrosternal chest pain. An electrocardiogram confirmed a diagnosis of ST-segment elevation myocardial infarction. The patient underwent angioplasty and received a bare-metal stent. Because significant disease was revealed in other arteries, CABG was scheduled. Clopidogrel was discontinued in preparation for surgery, and the patient received an infusion of eptifibatide 2 microg/kg/minute as bridging therapy to surgery for a total of 9 days. No major hemorrhagic or clinically evident thrombotic complications occurred before or after the surgery. Eptifibatide may be safe and effective as bridging therapy for patients with intracoronary stents who require CABG.

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“…Considering that all blood products use were based on intraoperative hematocrit monitoring or bleeding in the operative field, we speculated that the difference in platelet transfusion between the two groups might be due to the fact that the impairment of platelets by SRCP was more severe than other blood components. In this regard, a number of studies have shown that cardiac surgery can be performed without increasing bleeding complications when short‐acting GP IIb/IIIa blockers are given . For example, short‐acting GP IIb/IIIa blocker tirofiban can inhibit platelet aggregation and loss during CPB, reduce the expression of platelet P‐selectin at room temperature, and maintain platelet counts and function .…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, a number of studies have shown that cardiac surgery can be performed without increasing bleeding complications when short-acting GP IIb/ IIIa blockers are given. [26][27][28] For example, short-acting GP IIb/IIIa blocker tirofiban can inhibit platelet aggregation and loss during CPB, reduce the expression of platelet P-selectin at room temperature, and maintain platelet counts and function. 29 Cangrelor, an ultra-short-acting platelet ADP receptor P2Y12 blocker, can prevent platelet activation at low temperature CPB and reduce bleeding-related complications.…”

Section: F I G U R Ementioning

confidence: 99%

Perioperative blood product transfusion of two different perfusion strategies on pediatric patients undergoing aortic arch surgery

Tong

Zhang

et al. 2019

Artificial Organs

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Simple regional cerebral perfusion (SRCP) or cerebro‐myocardial perfusion (CMP) is selectively used in one‐stage complex aortic arch malformation repair. This analysis was performed to investigate the effect of CMP and SRCP on perioperative blood product consumption, and to evaluate whether these two strategies have different effects on the clinical outcomes. A retrospective analysis of 284 children with complicated aortic malformation from January 2010 to June 2018 was performed. The overall cohort was divided into SRCP group (n = 202) and CMP group (n = 82). A comprehensive comparison of perioperative blood product consumption‐related indexes was performed. Cardiopulmonary bypass time, cardiac arrest time, cooling, and rewarming time in the CMP group were significantly shorter than those in the SRCP group (P < .05). Chest tube time was 3.82 ± 1.33 days in the SRCP group compared to 3.42 ± 0.97 days in the CMP group (P = .005). Moreover, intraoperative platelet (PLT) transfusion volume (mL/kg) and rate (%) were significantly lower in the CMP group (P < .001). Multivariate regression analysis found that intraoperative PLT transfusion was significantly negatively correlated with CMP management [OR = 0.237 (0.110‐0.507), P < .001] and CPB time was independently associated with delayed chest tube removal (>3 days) [OR = 1.010 (1.001‐1.020), P = .031]. In‐hospital mortality and early postoperative adverse events were not significantly different between the two groups. In children with on‐pump complex aortic arch surgeries, CMP is more preferable than SRCP in blood protection. However, overall prognosis was not remarkably different between these two perfusion groups. They are both safe and feasible.

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Tirofiban therapy does not increase the risk of hemorrhage after emergency coronary surgery

Cited by 18 publications

References 0 publications

Tirofiban and emergency coronary surgery

Tirofiban and emergency coronary surgery

Prolonged Infusion of Eptifibatide as Bridge Therapy Between Bare‐Metal Stent Insertion and Cardiovascular Surgery: Case Report and Review of the Literature

Perioperative blood product transfusion of two different perfusion strategies on pediatric patients undergoing aortic arch surgery

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