Lemmer JH.  Metzdorff MT.  Krause AH.  Martin MA.  Okies JE.  Hill JG. Emergency coronary artery bypass graft surgery in abciximab treated patients. Annals of Thoracic Surgery 69: 90-95, 2000


    Although the platelet antiaggregant abciximab isfrequently used with percutaneous coronary interventions, resultsof emergency coronary artery bypass graft operations in patientsrecently treated with abciximab are poorly characterized. During a 29-month period, 12 patients required emergencycoronary artery bypass grafting within 12 hours (mean, 1.9 hours)of abciximab therapy. Our full standard heparin dose regimenwas used (mean heparin dose, 53,000 U per patient). Each patientreceived a single platelet transfusion dose after protamineadministration, and further blood products were transfused asnecessary. Clinical outcome and transfusion requirements werecompared with predicted results based on risk-adjusted historicalpatients. No patients died and none were returned to the operatingroom for coagulopathy-related bleeding. Per-patient transfusionrequirements were as follows: red blood cells, 3.6 units; apheresisplatelets, 1.4 units; and fresh frozen plasma, 1.5 units. Ascompared with predicted values, there was no excessive incidenceof mortality, stroke, or red blood cell transfusion requirements.The authors conclude that emergency coronary artery bypass graft operationsusing full-dose heparin can be performed successfully in acutelyischemic abciximab-treated patients. Prophylactic transfusionof platelets after protamine administration appears to be useful.