Thorac Cardiovasc Surg 2005; 53 - V54
DOI: 10.1055/s-2005-861961

Bridge-to-operation with the GPIIb/IIIa-antagonist Abciximab in high-risk coronary patients: ‘altering the rules’

F Schönhoff 1, N Kayhan 2, G Thomas 1, K Haase 3, M Borggrefe 3, H Katus 4, S Hagl 1, C Vahl 2
  • 1University Hospital Heidelberg, Department of Cardiac Surgery, Heidelberg
  • 2University Hospital Mainz, Thoracic and Cardiovascular Surgery, Mainz
  • 3University Hospital Mannheim, Department of Cardiology, Mannheim
  • 4University Hospital Heidelberg, Department of Cardiology, Heidelberg

Objectives: GPIIb/IIIa-antagonists are frequently used in the cardiological treatment of high-risk coronary patients even if the patient is suitable for surgical intervention. Yet, there is no consensus if in respect to any risk of bleeding GPIIb/IIIa-antagonists should be stopped before operation or if surgery should be delayed until the anticoagulating effects subsides. Aim of this study was to determine whether the GPIIb/IIIa-antagonist abciximab can be safely used as a bridge-to-operation (continous infusion until the operation starts, perfusion-time ≤36h) and if there is a benefit for this high-risk patient population in the perioperative course.

Material and Methods: From 6/2002 to 8/2003 140 patients who had to undergo primary aorto-coronary-bypass surgery for ongoing myocardial ischemia were enrolled in the present study. An elective control group of 49 patients was used as reference. The patients were classified as 'urgent', 'emergency' or 'ultima-ratio' using the EuroSCORE based on clinical criteria and received either clopidogrel, aspirin, heparin or additionally abciximab.

Results: Although the intraoperative need for blood products was higher in the abciximab group there was no significant difference in the 72h blood loss (1186 vs. 915ml) as well as in the overall blood loss (2243 vs. 2459ml). The hemodynamic situation of the abciximab patients after the operation was significantly better compared to the other groups. Compared to the control group 30-day-mortality was not increased (6.7 vs. 6.1%).

Conclusions: Application of GPIIb/IIIa-antagonists abciximab is a safe procedure to bridge the critical interval between cardiological intervention and surgical procedure especially in high-risk patients. In this group this strategy was associated with a significantly improved hemodynamic outcome and a reduction of the incidence of major ischemic complications in high-risk coronary patients.