Bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative setting
Abstract Objectives After elective cardiac surgery a postoperative anticoagulation is obligatory. With critically ill patients the conventional anticoagulation standard heparin is sometimes impossible, e.g. based on HIT II. Then, argatroban is currently a possible alternative, however, due to its im...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2020-01-01
|
Series: | Journal of Cardiothoracic Surgery |
Subjects: | |
Online Access: | https://doi.org/10.1186/s13019-020-1059-8 |
id |
doaj-854f2bcb2241486aa8b24878ed5afa45 |
---|---|
record_format |
Article |
spelling |
doaj-854f2bcb2241486aa8b24878ed5afa452021-01-31T12:14:01ZengBMCJournal of Cardiothoracic Surgery1749-80902020-01-011511810.1186/s13019-020-1059-8Bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative settingMatthias Klingele0Julia Enkel1Timo Speer2Hagen Bomberg3Lea Baerens4Hans-Joachim Schäfers5Department of Internal Medicine, Nephrology and Hypertension, Saarland University Medical CentreDepartment of Internal Medicine, Nephrology and Hypertension, Saarland University Medical CentreDepartment of Internal Medicine, Nephrology and Hypertension, Saarland University Medical CentreDepartment of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical CentreDepartment of Nephrology, HochtaunusklinikenDepartment of Thoracic and Cardiovascular Surgery, Saarland University Medical CentreAbstract Objectives After elective cardiac surgery a postoperative anticoagulation is obligatory. With critically ill patients the conventional anticoagulation standard heparin is sometimes impossible, e.g. based on HIT II. Then, argatroban is currently a possible alternative, however, due to its impaired metabolism in critically ill patients, anticoagulation effect is harder to anticipate, thus resulting in higher bleeding risk. Furthermore, to date no antidote is available. Hence, severe postoperative bleeding incidents under anticoagulation are commonly mono-causal attributed to the anticoagulation itself. This study concentrates on the number of well-defined postoperative bleeding incidents before any anticoagulation started, then actually under argatroban as well as compared to those under heparin (or switched from heparin to argatroban). Material and methods Retrospective study including 215 patients undergoing elective cardiac surgery with a postoperative stay in ICU ≥48 h. Postoperative bleeding complications before and after start of anticoagulation were evaluated. Definition of bleeding complications were: decrease of hemoglobin by more than 2 g/dl without dilution (mean value of volume balance plus one standard deviation) and/or increased need of red blood cell transfusion/day (average transfusion rate + 2 standard deviations). Results Within the study group of 215 patients, 143 were treated with heparin, 43 with argatroban, 29 switched from heparin to argatroban. Overall, 26.5% (57/215) postoperative bleeding complications occurred. In 54.4% (31/57) bleeding complications occurred before start of anticoagulation; in 43.6% (26/57) after. Of these, 14 bleeding incidents occurred under heparin 9.8% (14/143), 6 under argatroban 14% (6/43) and 6 switched 20.7% (6/29). Higher bleeding complications before start of anticoagulation was related to concomitant factors influencing the overall bleeding risk; e.g. score of severity of illness. These observations further correlate with postoperative, but not anticoagulation induced mortality rate of 2.8% of then given heparin, 20.9% then argatroban, 20.7% then switched. Conclusions Postoperative bleeding complications cannot simply be attributed to anticoagulation since occurring often before anticoagulation was started. The risk for bleeding complications after start of anticoagulation was quite comparable for argatroban and heparin. Accordingly, the influence of argatroban on bleeding complications in the postoperative period may be less significant than previously thought.https://doi.org/10.1186/s13019-020-1059-8AnticoagulationArgatrobanBleeding complication |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Matthias Klingele Julia Enkel Timo Speer Hagen Bomberg Lea Baerens Hans-Joachim Schäfers |
spellingShingle |
Matthias Klingele Julia Enkel Timo Speer Hagen Bomberg Lea Baerens Hans-Joachim Schäfers Bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative setting Journal of Cardiothoracic Surgery Anticoagulation Argatroban Bleeding complication |
author_facet |
Matthias Klingele Julia Enkel Timo Speer Hagen Bomberg Lea Baerens Hans-Joachim Schäfers |
author_sort |
Matthias Klingele |
title |
Bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative setting |
title_short |
Bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative setting |
title_full |
Bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative setting |
title_fullStr |
Bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative setting |
title_full_unstemmed |
Bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative setting |
title_sort |
bleeding complications after cardiac surgery, before anticoagulation start and then with argatroban or heparin in the early postoperative setting |
publisher |
BMC |
series |
Journal of Cardiothoracic Surgery |
issn |
1749-8090 |
publishDate |
2020-01-01 |
description |
Abstract Objectives After elective cardiac surgery a postoperative anticoagulation is obligatory. With critically ill patients the conventional anticoagulation standard heparin is sometimes impossible, e.g. based on HIT II. Then, argatroban is currently a possible alternative, however, due to its impaired metabolism in critically ill patients, anticoagulation effect is harder to anticipate, thus resulting in higher bleeding risk. Furthermore, to date no antidote is available. Hence, severe postoperative bleeding incidents under anticoagulation are commonly mono-causal attributed to the anticoagulation itself. This study concentrates on the number of well-defined postoperative bleeding incidents before any anticoagulation started, then actually under argatroban as well as compared to those under heparin (or switched from heparin to argatroban). Material and methods Retrospective study including 215 patients undergoing elective cardiac surgery with a postoperative stay in ICU ≥48 h. Postoperative bleeding complications before and after start of anticoagulation were evaluated. Definition of bleeding complications were: decrease of hemoglobin by more than 2 g/dl without dilution (mean value of volume balance plus one standard deviation) and/or increased need of red blood cell transfusion/day (average transfusion rate + 2 standard deviations). Results Within the study group of 215 patients, 143 were treated with heparin, 43 with argatroban, 29 switched from heparin to argatroban. Overall, 26.5% (57/215) postoperative bleeding complications occurred. In 54.4% (31/57) bleeding complications occurred before start of anticoagulation; in 43.6% (26/57) after. Of these, 14 bleeding incidents occurred under heparin 9.8% (14/143), 6 under argatroban 14% (6/43) and 6 switched 20.7% (6/29). Higher bleeding complications before start of anticoagulation was related to concomitant factors influencing the overall bleeding risk; e.g. score of severity of illness. These observations further correlate with postoperative, but not anticoagulation induced mortality rate of 2.8% of then given heparin, 20.9% then argatroban, 20.7% then switched. Conclusions Postoperative bleeding complications cannot simply be attributed to anticoagulation since occurring often before anticoagulation was started. The risk for bleeding complications after start of anticoagulation was quite comparable for argatroban and heparin. Accordingly, the influence of argatroban on bleeding complications in the postoperative period may be less significant than previously thought. |
topic |
Anticoagulation Argatroban Bleeding complication |
url |
https://doi.org/10.1186/s13019-020-1059-8 |
work_keys_str_mv |
AT matthiasklingele bleedingcomplicationsaftercardiacsurgerybeforeanticoagulationstartandthenwithargatrobanorheparinintheearlypostoperativesetting AT juliaenkel bleedingcomplicationsaftercardiacsurgerybeforeanticoagulationstartandthenwithargatrobanorheparinintheearlypostoperativesetting AT timospeer bleedingcomplicationsaftercardiacsurgerybeforeanticoagulationstartandthenwithargatrobanorheparinintheearlypostoperativesetting AT hagenbomberg bleedingcomplicationsaftercardiacsurgerybeforeanticoagulationstartandthenwithargatrobanorheparinintheearlypostoperativesetting AT leabaerens bleedingcomplicationsaftercardiacsurgerybeforeanticoagulationstartandthenwithargatrobanorheparinintheearlypostoperativesetting AT hansjoachimschafers bleedingcomplicationsaftercardiacsurgerybeforeanticoagulationstartandthenwithargatrobanorheparinintheearlypostoperativesetting |
_version_ |
1724317413316493312 |