20. Risk of Platelet Inhibitors with Emergency CABG

If physicians would just keep doing what they did last year, the problem would not get worse. But, no, that would be too simple. We now have platelet inhibitors. What is the risk of platelet inhibitors when mixed with CABG surgery? You have seen the case: The PTCA failed, they were given a platelet inhibitor just prior to the failed PTCA, they are bleeding from the hole in the coronary where the PCI wire perforated. What happens next? Approximately 2% to 4% of patients undergo urgent or emergency coronary artery bypass grafting (CABG) for complications of percutaneous coronary intervention (PCI) after treatment with glycoprotein (GP) IIb/IIIa inhibitors. Unfortunately the risk of Death 15%, MI 12%, and CVA 5% are increased by the lethal combination of platelet inhibitors and emergency CABG. Eptifibatide and tirofiban less risk than abciximab in the setting of emergency or urgent CABG after failed PCI.

 

 

 

Clopidogrel treatment before percutaneous coronary intervention reduces adverse cardiac events Berglund et. al. J Invasive Cardiol. 2002 May;14(5):243-6, Mehta et. al. Lancet. 2001 Aug 18;358(9281):527-33

	Approximately 2% to 4% of patients undergo urgent or emergency coronary artery bypass grafting (CABG) for complications of percutaneous coronary intervention (PCI) after treatment with glycoprotein (GP) IIb/IIIa inhibitors.
	Pharmacokinetic and pharmacodynamic properties of GP IIb/IIIa inhibitors play a large role in determining the safety of their use in the setting of urgent or emergency CABG procedures.
	Abciximab: increased risk of hemorrhage and the requirement of platelet transfusions if surgery is performed within 12 h of abciximab discontinuation.
	Eptifibatide a similar risk compared with placebo, even when surgery is performed within 2 h of eptifibatide cessation.
	Tirofiban show that bleeding is not increased when compared with acetylsalicylic acid or heparin.
	Circulation. 2002 Oct 29;106(18):2346-50
	Death 15%, MI 12%, CVA 5% Circulation. 2002 Oct 29;106(18):2346-50