Preoperative use of enoxaparin increases the risk of postoperative bleeding and re-exploration in cardiac surgery patients

Susan B. McDonald, Maurizio Renna, Edward L. Spitznagel, Michael Avidan, Charles W. Hogue, Marc R. Moon, Benico Barzilai, Rao Saleem, Jerome M. McDonald, George J. Despotis

Research output: Contribution to journalArticle

Abstract

Objective: The purpose of this study was to investigate if the preoperative use of new platelet inhibitors and low-molecular-weight heparins may contribute to bleeding after cardiac surgery. Design: Retrospective data review. Setting: University teaching hospital. Participants: One hundred eleven patients divided in 5 groups. Interventions: Patients were grouped according to preoperative antithrombotic regimen: group 1, control, no agents (n = 55); group 2, clopidogrel (n = 9); group 3, enoxaparin (n = 17); group 4, any GP IIb/IIIa inhibitor (n = 14); and group 5, any drug combination (n = 15). Data included cumulative mediastinal chest tube drainage, allogeneic blood transfusions, total blood donor exposures, and re-exploration. Measurements and Main Results: Use of any drug (groups 2-5) resulted in greater total blood transfusions and donor exposure (p = 0.0003) than control, especially red cells (p = 0.002) and platelets (p = 0.006). A greater percentage of patients on enoxaparin required mediastinal re-exploration for nonsurgical bleeding versus control (3/17 v 0/55, p = 0.001). The use of enoxaparin was associated with significantly higher chest tube output after the first 24 hours postoperatively (p = 0.048). Conclusion: Newer antithrombotic agents were associated with greater transfusion rates and total donor exposures. Enoxaparin use was associated with greater overall blood loss and with higher incidence of mediastinal re-exploration. The relative risk-benefit ratio of reduced periprocedure morbidity versus increased bleeding complications has yet to be determined.

Original languageEnglish (US)
Pages (from-to)4-10
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume19
Issue number1
DOIs
StatePublished - Feb 2005
Externally publishedYes

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Enoxaparin
Thoracic Surgery
Hemorrhage
Chest Tubes
clopidogrel
Blood Donors
Blood Transfusion
Platelet Membrane Glycoprotein IIb
Fibrinolytic Agents
Low Molecular Weight Heparin
Platelet Aggregation Inhibitors
Drug Combinations
Teaching Hospitals
Drainage
Blood Platelets
Odds Ratio
Tissue Donors
Morbidity
Control Groups
Incidence

Keywords

  • Bleeding
  • Complications
  • Heparin
  • Inhibitors
  • Platelets
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Preoperative use of enoxaparin increases the risk of postoperative bleeding and re-exploration in cardiac surgery patients. / McDonald, Susan B.; Renna, Maurizio; Spitznagel, Edward L.; Avidan, Michael; Hogue, Charles W.; Moon, Marc R.; Barzilai, Benico; Saleem, Rao; McDonald, Jerome M.; Despotis, George J.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 19, No. 1, 02.2005, p. 4-10.

Research output: Contribution to journalArticle

McDonald, SB, Renna, M, Spitznagel, EL, Avidan, M, Hogue, CW, Moon, MR, Barzilai, B, Saleem, R, McDonald, JM & Despotis, GJ 2005, 'Preoperative use of enoxaparin increases the risk of postoperative bleeding and re-exploration in cardiac surgery patients', Journal of Cardiothoracic and Vascular Anesthesia, vol. 19, no. 1, pp. 4-10. https://doi.org/10.1053/j.jvca.2004.11.002
McDonald, Susan B. ; Renna, Maurizio ; Spitznagel, Edward L. ; Avidan, Michael ; Hogue, Charles W. ; Moon, Marc R. ; Barzilai, Benico ; Saleem, Rao ; McDonald, Jerome M. ; Despotis, George J. / Preoperative use of enoxaparin increases the risk of postoperative bleeding and re-exploration in cardiac surgery patients. In: Journal of Cardiothoracic and Vascular Anesthesia. 2005 ; Vol. 19, No. 1. pp. 4-10.
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AU - Renna, Maurizio

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AU - Avidan, Michael

AU - Hogue, Charles W.

AU - Moon, Marc R.

AU - Barzilai, Benico

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N2 - Objective: The purpose of this study was to investigate if the preoperative use of new platelet inhibitors and low-molecular-weight heparins may contribute to bleeding after cardiac surgery. Design: Retrospective data review. Setting: University teaching hospital. Participants: One hundred eleven patients divided in 5 groups. Interventions: Patients were grouped according to preoperative antithrombotic regimen: group 1, control, no agents (n = 55); group 2, clopidogrel (n = 9); group 3, enoxaparin (n = 17); group 4, any GP IIb/IIIa inhibitor (n = 14); and group 5, any drug combination (n = 15). Data included cumulative mediastinal chest tube drainage, allogeneic blood transfusions, total blood donor exposures, and re-exploration. Measurements and Main Results: Use of any drug (groups 2-5) resulted in greater total blood transfusions and donor exposure (p = 0.0003) than control, especially red cells (p = 0.002) and platelets (p = 0.006). A greater percentage of patients on enoxaparin required mediastinal re-exploration for nonsurgical bleeding versus control (3/17 v 0/55, p = 0.001). The use of enoxaparin was associated with significantly higher chest tube output after the first 24 hours postoperatively (p = 0.048). Conclusion: Newer antithrombotic agents were associated with greater transfusion rates and total donor exposures. Enoxaparin use was associated with greater overall blood loss and with higher incidence of mediastinal re-exploration. The relative risk-benefit ratio of reduced periprocedure morbidity versus increased bleeding complications has yet to be determined.

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KW - Bleeding

KW - Complications

KW - Heparin

KW - Inhibitors

KW - Platelets

KW - Surgery

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