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Current status of cardiac surgery in the abciximab-treated patient.

Publication ,  Journal Article
Silvestry, SC; Smith, PK
Published in: Ann Thorac Surg
August 2000

BACKGROUND: Early surgical experience with abciximab and other glycoprotein (GP) IIb/IIIa receptor antagonists suggested a tendency toward excessive bleeding in patients treated with these agents. With increased use of GP IIb/IIIa inhibitors, cardiac surgeons have become aware of their hazards, as well as potential benefits, during and after cardiac surgery. Although published experience with the GP IIb/IIIa inhibitor abciximab is limited in scope, it suggests management guidelines for urgent coronary artery bypass grafting in abciximab-treated patients. As more urgent and elective surgical data are presented, a clearer picture of true bleeding risk will evolve. METHODS: Two large retrospective studies examining reexploration for postoperative bleeding have identified risk factors, including advanced age, preoperative renal dysfunction, and operation/reoperation other than coronary artery bypass grafting. Other risk factors for transfusion requirement and increased morbidity and mortality are emergent operation, postoperative coagulopathy, and prolonged bypass time. RESULTS: To minimize real and perceived bleeding effects, some authors have suggested delaying operation until platelet function has normalized, employing platelet transfusion in patients in whom delay is not possible, and exacting heparin management during cardiopulmonary bypass. Later reports have not noted increased bleeding when incorporating these modifications plus early platelet transfusion, if required. Further experience with abciximab removal and reversal may also ultimately reduce or eliminate excess transfusion requirements. CONCLUSIONS: Surgeons should work closely with perfusionists and anesthesiologists on issues of heparinization in the abciximab-treated patient. The apparent paradox of preserved platelet numbers and depressed platelet function with abciximab use has led to speculation about a role for this agent and other shorter-acting GP IIb/IIIa inhibitors for "platelet anesthesia" during cardiopulmonary bypass. With careful surgical care, GP IIb/IIIa receptor antagonists can maintain and improve beneficial outcomes.

Duke Scholars

Published In

Ann Thorac Surg

DOI

ISSN

0003-4975

Publication Date

August 2000

Volume

70

Issue

2 Suppl

Start / End Page

S12 / S19

Location

Netherlands

Related Subject Headings

  • Respiratory System
  • Postoperative Hemorrhage
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Immunoglobulin Fab Fragments
  • Humans
  • Cardiac Surgical Procedures
  • Blood Coagulation Tests
  • Antibodies, Monoclonal
  • Angina Pectoris
 

Citation

APA
Chicago
ICMJE
MLA
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Silvestry, S. C., & Smith, P. K. (2000). Current status of cardiac surgery in the abciximab-treated patient. Ann Thorac Surg, 70(2 Suppl), S12–S19. https://doi.org/10.1016/s0003-4975(00)01602-7
Silvestry, S. C., and P. K. Smith. “Current status of cardiac surgery in the abciximab-treated patient.Ann Thorac Surg 70, no. 2 Suppl (August 2000): S12–19. https://doi.org/10.1016/s0003-4975(00)01602-7.
Silvestry SC, Smith PK. Current status of cardiac surgery in the abciximab-treated patient. Ann Thorac Surg. 2000 Aug;70(2 Suppl):S12–9.
Silvestry, S. C., and P. K. Smith. “Current status of cardiac surgery in the abciximab-treated patient.Ann Thorac Surg, vol. 70, no. 2 Suppl, Aug. 2000, pp. S12–19. Pubmed, doi:10.1016/s0003-4975(00)01602-7.
Silvestry SC, Smith PK. Current status of cardiac surgery in the abciximab-treated patient. Ann Thorac Surg. 2000 Aug;70(2 Suppl):S12–S19.
Journal cover image

Published In

Ann Thorac Surg

DOI

ISSN

0003-4975

Publication Date

August 2000

Volume

70

Issue

2 Suppl

Start / End Page

S12 / S19

Location

Netherlands

Related Subject Headings

  • Respiratory System
  • Postoperative Hemorrhage
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Immunoglobulin Fab Fragments
  • Humans
  • Cardiac Surgical Procedures
  • Blood Coagulation Tests
  • Antibodies, Monoclonal
  • Angina Pectoris