| Author: Rick Young |
About 13 million people in the United States have coronary artery disease and many of them take antiplatelet drugs like aspirin or clopidogrel every day to reduce their risk of a heart attack. This year more than 300,000 people will require heart bypass surgery, including a growing number of patients who are on antiplatelet medication.
Drugs like aspirin and clopidogrel are called antiplatelet drugs because they work by keeping platelets in the blood from sticking together and forming the clots that can cause heart attack, stroke and other ischemic events. For instance, a recent study involving first-time heart surgery patients found that receiving aspirin within five days before surgery was associated with a lower risk of mortality after surgery.
However, since antiplatelet drugs prevent the formation of clots, previous research had suggested that receiving antiplatelet therapy less than five days prior to heart bypass surgery could lead to a greater need for blood transfusions. In patients exposed to antiplatelet therapy, surgeons were left to balance the risk of increased operative blood loss against the risks of discontinuing antiplatelet treatment or delaying surgery.
"When you discontinue antiplatelet therapy prior to heart bypass surgery, you expose the patient to the risks they began antiplatelet therapy to avoid in the first place," said Dr. Jan van der Linden, professor of cardiac anesthesia, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. "When you stop antiplatelet therapy, you increase the risk of heart attack, stroke and other potentially serious complications. This is especially true in the days before surgery, when the risk is highest."
Recent studies suggest that a drug called Trasylol? (aprotinin injection) can help. In a study published in the annual surgical supplement of Circulation -; the Journal of the American Heart Association, heart bypass surgery patients on antiplatelet therapy who were administered the drug lost 37 percent less blood, and 33 percent fewer patients were exposed to transfusions than those who did not receive it. Study results showed that with Trasylol, patients can continue on antiplatelet therapy up until the time of surgery - reducing their risk of heart attack, stroke and death prior to the operation - and still reduce the amount of blood they lose during the procedure. Trasylol is the only drug approved by the U.S. Food and Drug Administration to reduce bleeding and the need for blood transfusions during heart bypass surgery.
While blood transfusions can be life-saving, they can also be associated with poor patient outcomes, including allergic reaction, infection, increased hospital stay and an increased risk for stroke.
"These studies add to a growing body of clinical evidence showing that we can use antiplatelet medication to reduce the risk of cardiac events during the critical days leading up to surgery without complicating the actual procedure," said Dr. van der Linden. "Continuing antiplatelet therapy in the days leading up to the operation is an effective strategy for heart bypass patients, as favorable outcomes may be achieved when using Trasylol to reduce bleeding and the need for blood transfusion during the procedure." |
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