Effect of Anti?Platelet Therapy on Peri?Operative Blood Loss in Patients Undergoing Off?Pump Coronary Artery Bypass Grafting

Purpose:The purpose of this study was to review the effect of the pre?operative use of clopidogrel and aspirin on peri?operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG). Materials and Methods: A total of 1200 patients who underwent off?pump CABG (OPCABG) between 2010 and 2012 were retrospectively studied. Patients were divided into three groups: group 1: discontinued aspirin and clopidogrel 6 days prior to surgery (n = 468), group 2: discontinued both drugs 3 to 5 days prior to surgery (n = 621), and group 3: discontinued both drugs 2 days prior to surgery (n = 111). The bleeding pattern and blood product transfusion were studied and compared between the groups. Patients having history of other drugs affecting the coagulation profile, other organ dysfunction, on?pump CABG, and the combined procedure were excluded from the study. Results: Group 2 patients had a higher rate of bleeding and a reduced mean value of hemoglobin (Hb) as compared to other groups. The same results were seen in blood and blood product transfusion. Patients of group 2 and group 3 were associated with higher blood loss in terms of drainage at 12 and 24 hours. Post?operatively, this was statistically significant. Re?exploration was statisitically significant in group 3 patients (9.01%) than in group 2 (2.58%) and group 1 (1.07%) patients. Conclusion: The pre?operative use of clopidogrel and aspirin in patients undergoing OPCABG showed limited clinical benefits; however, its use significantly increased the risk of bleeding and blood transfusion, thus increasing morbidity and resource utilization. Hence, clopidogrel and aspirin should be stopped at least 6 days prior to surgery.

The Impact of Metabolic Syndrome on Post-operative Bleeding and In-hospital Prognosis in Patients With Coronary Artery Bypass Grafting / 中国循环杂志

Objective: To explore the impact of metabolic syndrome (MS) on post-operative bleeding and in-hospital prognosis in patients with coronary artery bypass grafting (CABG). Methods: A total of 542 patients received CABG in Fuwai hospital from 2012-06 to 2012-09 were enrolled. Based on existing MS, the patients were divided into 2 groups: MS group, n=223 and Non-MS group, n=319. The amounts of 24 h post-operative bleeding and total bleeding were compared between 2 groups; the impact of MS for in-hospital prognosis was studied. Results: Compared with Non-MS group, MS group had the higher ratio of female patients (17.9％ vs 29.1％), P=0.002; the lower ratio of patients with plasma transfusion during operation and post-operation (20.7％ vs 12.6％), P=0.015 and the higher ratio of patients with zero plasma transfusion during operation and post-operation (79.3％ vs 87.5％), P=0.015. The median of 24h post-operative bleeding amount in MS group was lower [710.00(530.00, 950.00)ml vs 580.00(430.00, 790.00)ml, P<0.001]. The ratio of patients with total post-operative bleeding amount from (0-500)ml and (501-1000)ml was higher in MS group(4.4％ vs 10.8％, P=0.006;41.1％ vs 53.4％, P=0.005,respectively). MS group had the lower ratios of patients with 24 h post-operative bleeding amount>1000 ml, P=0.004, with total post-operative bleeding amount from (1001-2000) ml, P=0.001 and with total post-operative bleeding amount>2001 ml,P=0.044. Conclusion: MS patients had the lower amounts of peri-operative plasma transfusion and post-operative bleeding in CABG;while it had no impact on in-hospital prognosis.

Rare post-operative complications in a previously undiagnosed Congenital Factor X deficiency patient

Factor X (FX) deficiency is a rare autosomal recessive congenital bleeding disorder. The clinical presentation is among the most severe among the rare coagulation defects. Thus, majority of diagnosed patients will receive factor replacement therapy before surgical manipulation. However, the diagnosis of FX deficiency may be overlooked because it is a rare entity. This is a case report of a 15-year-old male patient who was diagnosed with FX deficiency after developing post-operative complications. With regular fresh frozen plasma infusion given, the patient responded well and recovered. However, had he been diagnosed earlier pre-operatively, the post-operative complication could have been prevented. Therefore, pre-operative coagulation screening should be performed in patients with significant bleeding history in both emergency and elective situations to prevent surgical morbidity related to post-operative bleeding.

Is stopping of anticoagulant therapy really required in a minor dental surgery?: How about in an endodontic microsurgery?

Nowadays, oral anticoagulants are commonly prescribed to numerous patients for preventing cardiovascular accident such as thromboembolism. An important side effect of anticoagulant is anti-hemostasis. In a major surgery, the oral anticoagulant therapy (OAT) regimen must be changed before the surgery for proper post-operative bleeding control. However, in a minor dental surgery and endodontic surgery, the necessity for changing or discontinuing the OAT is open to debate. In this study, risks of the consequences were weighed and analyzed. In patients who stop the OAT, the occurrence of thromboembolic complication is rare but the result is fatal. In patients who continuing the OAT, post-operative bleeding can be controlled well with the local hemostatic measures. In the endodontic surgery, there are almost no studies about this issue. The intra-operative bleeding control is particularly important in the endodontic surgery because of its delicate and sensitive procedures such as inspection of resected root surface using dental microscope and retrograde filling. Further studies are necessary about this issue in the viewpoint of endodontic surgery.

Analysis and Consideration of the Complications of Laparoscopic Cholecystectomy

PURPOSE: Laparoscopic cholecystectomy has replaced open cholecystectomy as the standard treatment and it has widely gained rapid acceptance. However, laparoscopic cholecystectomy has many complications and it can require conversion to open cholecystectomy or further management. We reviewed our cases for determining the complications and clinical results in order to improve the efficacy and safety of laparoscopic cholecystectomy in our hospital. METHODS: The data from 3,224 laparoscopic cholecystectomies that were performed at our hospital from January 1995 to December 2004 were reviewed retrospectively. The pre-operative laboratory data, operative findings, post-operative pathologic findings, complications and proper treatment were evaluated. RESULTS: 52 of all the patients developed complications. The median patient age was 51.8+/-11.6 years, and the median admission time was 29.9+/-10.6 days. The most common complications were post operative bleeding (20 case), and bile duct injury (15 cases). A collection of bile was noted in 12 cases. The treatment of complications were operations (16 case) radiologic interventions (14 case), and observation with conservative management (22 case). CONCLUSION: There were various complications of laparoscopic cholecystectomy, and these patients needed a longer hospital stay and operative treatment. So, improvement of surgeons' skill with a carefully approach and better understanding of the anatomical variations of the biliary tree and vascular system, recognition of pre-operative patients' general condition and the severity of inflammation, and prompt and proper management for complications should be done to prevent serious problems.