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Letters to the Editor

Guideline on antiplatelet and anticoagulation management in cardiac surgery

Department of Anesthesia and Pain Management, Eaton North 3-453, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, MSG 2C4, Canada

Received 15 October 2008; accepted 19 November 2008.

^_* Corresponding author. Address: Department of Anesthesia and Pain Medicine, Eaton North 3-453, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. Tel.: +1 416 340 4800x2840; fax: +1 416 340 3698. (Email: rita.katznelson{at}uhn.on.ca).

Key Words: Tranexamic acid • Coronary magnetic resonance imaging • Cardiac surgery

We congratulate Dunning and colleagues for their guideline on antiplatelet and anticoagulation management in cardiac surgery [1]. However, we disagree with the authors’ statement regarding a lack of studies demonstrating safety of perioperative tranexamic acid (TA) administration and venous graft patency.

Our research group conducted a double-blind prospective randomized controlled trial exploring the very issue of intra-operative administration of TA and early saphenous vein graft (SVG) patency in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass (CPB) [2]. A total of 312 patients were randomized to receive either TA or placebo. The primary objective of this study was to determine the equivalency of SVG patency rates between the treatment and placebo groups. In 237 patients saphenous vein graft patency was assessed with magnetic resonance imaging during the first month postoperatively. Our results showed insignificant variation in graft patency rates between the two groups. Consequently, TA could be advocated for routine use in patients undergoing coronary revascularization procedures with CPB to minimize postoperative bleeding and reduce perioperative blood product transfusion rates.

References

1. Dunning J, Versteegh M, Fabbri A, Pavie A, Kolh P, Lockowandt U, Nashef SAM. Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg 2008;34:73-92.[Abstract/Free Full Text]
2. Karski J, Djaiani G, Carroll J, Iwanochko M, Seneviratne P, Liu P, Kucharczyk W, Fedorko L, David T, Cheng D. Tranexamic acid and early saphenous vein graft patency in conventional coronary artery bypass graft surgery: a prospective randomized controlled clinical trial. J Thorac Cardiovasc Surg 2005;130(2):309-314.[Abstract/Free Full Text]

This article has been cited by other articles:

				J. Dunning Reply to Katznelson et al. Tranexamic acid is safe with regard to vein graft patency Eur. J. Cardiothorac. Surg., March 1, 2009; 35(3): 555 - 555. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jacek Karski Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Katznelson, R. Articles by Karski, J. Search for Related Content PubMed Articles by Katznelson, R. Articles by Karski, J. Related Collections Cardiac - pharmacology Cardiac - other