Aabha Divya

and 10 more

Aim: Post-operative bleeding remains a significant risk after cardiac surgery. Despite adequate protamine reversal of heparin intraoperatively, protein-bound heparin causes anticoagulant effect, leading to bleeding in the post-operative period. The aim of this study is to whether the use of a four-hour, low dose protamine infusion in intensive care would reduce post-operative bleeding and hence, blood transfusion requirements. Methods: A retrospective cohort study of seven hundred and two patients, who underwent elective or urgent coronary artery bypass grafting from April 2014 and January 2017, were divided into two groups based on who received post-operative protamine infusion (Group A, 472 patients) versus those who did not (Group B, 230 patients). They were assessed for amount of post-operative mediastinal and pleural drainage for the first 24 hours, use of post-operative transfusion of blood products, postoperative hospital stay, and re-exploration. Results: We found no significant difference between the rate of bleeding in either of the groups. No significant difference was observed in blood product requirements as well. In the sub-group consisting of patients with high BMI (BMI ≥30), who received protamine infusion, post-operative platelets transfusion was found to be significantly less. Conclusions: Our results suggest that a low dose protamine infusion given in the immediate postoperative period does not lead to any significant clinical benefits. Both patients receiving and not receiving the infusion had similar postoperative drainage, transfusion requirements, haemorrhagic morbidity, mortality and length of hospital stay.

Vincenzo Caruso

and 5 more

Background and aim of the study: Aim of this study is to compare the incidence of postoperative bleeding events, identified as pericardial effusion, for those patients undergoing cardiac surgery and discharged on vitamin K antagonist (VKA) versus those discharged on NOACs. Methods: This was a retrospective observational cohort study; from July 2017 to July 2019, all the patients who underwent any cardiac surgical procedure and discharged on any oral anticoagulant, were rolled in the study. The study variables and setting followed the STROBE checklist. The final cohort was constituted by 382 patients (mean age 70±11.2 years); 260(68.1%) patients were discharged on VKA and 122(31.9%) were discharged on NOACs. The primary end point was the incidence of major postoperative bleeding, defined as pericardial effusion requiring surgical re-exploration. The key secondary composite end point was the late re-admission for pericardial effusion. Results: The overall incidence of in-hospital immediate bleeding events, with need of re-exploration for pericardial effusion, was 4.7% (n=18). The incidence of re-admission for pericardial effusion was 3.1% (n=12). Eight of those patients had surgical re-exploration: four patients were discharged on NOACs and the remnant four ones were discharged on VKA. No significant relationships were observed between the different oral anticoagulants and the incidence of pericardial effusion, at any time. No ischemic and thromboembolic events were recorded. Conclusions: The use of non-vitamin K antagonist oral anticoagulant, in post cardiac surgery patients, does not increase the incidence of major bleeding events, intended as immediate or late pericardial effusion.