Management of perioperative bleeding risk in patients on antithrombotic medications undergoing cardiac surgery – a systematic review
Matejic-Spasic M, Hassan K, Thielmann M, Geidel S, Storey RF, Schmoeckel M, Adamson H, Deliargyris EN, Wendt D. J Thorac Disease 2022; epub
08/2022
The aim of this review was to evaluate perioperative bleeding complications in patients on dual antiplatelet therapy (DAPT) or direct-acting oral anticoagulants (DOACs) undergoing high-bleeding risk cardiovascular surgery and to present currently available potential solutions to mitigate antithrombotic therapy-related bleeding complications. Relevant articles on bleeding complications in cardiac surgery from last 10 years in Medline (PubMed) were screened. An additional search evaluating potential solutions to mitigate bleeding complications was also performed. From all reviewed studies, a total of 19 articles could be included evaluating the risk for bleeding in cardiac surgery related to DAPT or DOACs, and 10 papers evaluating antithrombotic drug reversal or removal in this setting. Reported bleeding rates ranged between 18% and 41%, a remarkably wide variability. New costly reversal agents are available but have not been sufficiently tested in this setting. Antithrombotic removal by innovative intraoperative hemoadsorption has been shown to be associated with a significant decrease in re-thoracotomy rate, overall procedure duration, administered transfusion volumes, chest-tube drainage, and length of hospitalization. Results from ongoing trials should provide more informed insights concerning the efficacy and safety of several potential solutions.
