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New Concept about Perioperative Asymptomatic or Symptomatic Deep
Clinical & Experimental Cardiology

Clinical & Experimental Cardiology
Open Access

ISSN: 2155-9880

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Editorial - (2013) Volume 0, Issue 0

New Concept about Perioperative Asymptomatic or Symptomatic Deep Vein Thrombosis Prophylaxis in Coronary Artery Bypass Graft

Seyed Mohammad Yousof Mostafavi Pour Manshadi*
General Practitioner, Department of Medicine, Ali be Abitaleb Medical College, Islamic Azad University, Yazd, Iran
*Corresponding Author: Seyed Mohammad Yousof Mostafavi Pour Manshadi, General Practitioner, Department of Medicine, Ali be Abitaleb Medical College, Islamic Azad University, No 159, 7th Boostan St., Pasdaran Ave. Yazd, Iran, Tel: +989133538922 Email:

Asymptomatic deep vein thrombosis (DVT) is a common complication that occurs around of coronary artery bypass graft (CABG). It is common cause of morbidity and mortality in this process [1-4].

DVT is seen in 70-80% of patients underwent coronary artery bypass graft. The incidence of DVT is decreased with pharmacologic prophylaxis [1-4]. However, there is no unique and acceptable consensus exists.

The common prophylaxis for this purpose is administering of Low Molecular Weight Heparin (LMWH) and unfractionated heparin (UFH) [5-9]. Heparin can affect on coagulation factors and fibrinolytic proteins and restrains them. It can not affect on platelet aggregation in primary hemostasis phase. Aspirin can affect on platelet aggregation and inhibit it [5-9].

Preventing from asymptomatic DVT with heparin alone was reported 60 % to 70% and with aspirin alone was reported 40% to 50% [10,11].

Administration of heparin and aspirin together can be useful to reduce asymptomatic DVT after CABG [12].

Without using prophylactic anticoagulation, the incidence of Venous Thrombo Embolism (VTE) is high after open heart surgery but with using it the incidence of VTE is lower significantly [12-14], however administration of anticoagulants may increase bleeding but it is not significantly.

Low Molecular Weight Heparin is the best choice for DVT prophylaxis after CABG especially in patients with advanced risk factors [15].

Prevention of VTE with antiplatelet agent or anticoagulation drugs was reported in previous studies [16,17]. In Addition, administering of anti platelet and anticoagulation drug together to decrease the rate of DVT is more effective rather than antiplatelet drug or anticoagulation drug alone [15-17]. For instance, administration of heparin and aspirin together is more effective than heparin or aspirin alone to prevent from DVT [12].

Administration of anticoagulation drug and antiplatelet drug, for example aspirin and heparin, does not increase the surgical bleeding significantly [12]. However, some previous studies found that surgical bleeding increased with using of anticoagulation drug and antiplatelet agent together or with the use of them alone [18].

It sounds that administration of anticoagulation drug and antiplatelet agent together is more useful and efficient than administration of one of them alone. Also it does not increase surgical bleeding significantly. Further studies are necessary to prove administration of anticoagulation drug and antiplatelet agent together for prophylaxis of DVT in CABG.

The present editorial focuses on importance and necessity of administration of anticoagulation drug and antiplatelet drug together as prophylaxis to prevent from DVT in CABG. It is important to prevent DVT (symptomatic and asymptomatic) in CABG because of its serious complications.

References

  1. Oger E (2000) Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 83: 657-660.
  2. Samama MM (2000) An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med 160: 3415-3420.
  3. Goldhaber SZ, Elliott CG (2003) Acute pulmonary embolism: part I: epidemiology, pathophysiology, and diagnosis. Circulation 108: 2726-2729.
  4. Dalen JE (2002) Pulmonary embolism: what have we learned since Virchow? Natural history, pathophysiology, and diagnosis. Chest 122: 1440-1456.
  5. Paparella D, Galeone A, Venneri MT, Coviello M, Scrascia G, et al. (2006) Activation of the coagulation system during coronary artery bypass grafting: comparison between on-pump and off-pump techniques. J Thorac Cardiovasc Surg 131: 290-297.
  6. Raja SG, Dreyfus GD (2006) Impact of off-pump coronary artery bypass surgery on postoperative bleeding: current best available evidence. J Card Surg 21: 35-41.
  7. White RH, Keenan CR (2009) Effects of race and ethnicity on the incidence of venous thromboembolism. Thromb Res 123 Suppl 4: S11-17.
  8. Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, et al. (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371: 387-394.
  9. Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, et al. (2004) Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126: 338S-400S.
  10. Goldhaber SZ, Tapson VF; DVT FREE Steering Committee (2004) A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 93: 259-262.
  11. Mattos MA, Londrey GL, Leutz DW, Hodgson KJ, Ramsey DE, et al. (1992) Color-flow duplex scanning for the surveillance and diagnosis of acute deep venous thrombosis. J Vasc Surg 15: 366-375.
  12. Mirhosseini SJ, Forouzannia SK, Mostafavi Pour Manshadi SM, Ali-Hassan-Sayegh S, Naderi N, et al. (2013) Comparison of aspirin plus heparin with heparin alone on asymptomatic perioperative deep vein thrombosis in candidates for elective off-pump coronary artery bypass graft: A randomized clinical trial. Cardiol J 20: 139-143.
  13. Josa M, Siouffi SY, Silverman AB, Barsamian EM, Khuri SF, et al. (1993) Pulmonary embolism after cardiac surgery. J Am Coll Cardiol 21: 990-996.
  14. Shammas NW (2000) Pulmonary embolus after coronary artery bypass surgery: a review of the literature. Clin Cardiol 23: 637-644.
  15. Tapson VF, Decousus H, Pini M, Chong BH, Froehlich JB, et al. (2007) Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest 132: 936-945.
  16. Mismetti P, Laporte-Simitsidis S, Tardy B, Cucherat M, Buchmüller A, et al. (2000) Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular-weight heparins: a meta-analysis of randomised clinical trials. Thromb Haemost 83: 14-19.
  17. Mismetti P, Laporte S, Darmon JY, Buchmüller A, Decousus H (2001) Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg 88: 913-930.
  18. Llau JV, Ferrandis R, López Forte C (2009) [Antiplatelet agents and anticoagulants: management of the anticoagulated surgical patient]. Cir Esp 85 Suppl 1: 7-14.
Citation: Mostafavi Pour Manshadi SMY (2013) New Concept about Perioperative Asymptomatic or Symptomatic Deep Vein Thrombosis Prophylaxis in Coronary Artery Bypass Graft. J Clin Exp Cardiolog 4:e131.

Copyright: © 2013 Mostafavi Pour Manshadi SMY. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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