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Guideline on antiplatelet and anticoagulation management in cardiac surgery

^a Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
^b Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
^c Department of Cardiac Surgery, Vicenzo Hospital, Italy
^d Institute of Cardiology, La Pitié-Salpêtrière Hospital, Paris, France
^e Department of Cardiothoracic Surgery, University Hospital of Liege, Liege, Belgium
^f Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
^g Department of Cardiothoracic Surgery, Papworth Hospital CB23 3RE, Cambridge, UK

Received 12 December 2007; received in revised form 15 February 2008; accepted 19 February 2008.

^_* Corresponding author. Tel.: +44 1480 364299; fax: +44 1480 364744. (Email: sam.nashef{at}papworth.nhs.uk).

This document presents a professional view of evidence-based recommendations around the issues of antiplatelet and anticoagulation management in cardiac surgery. It was prepared by the Audit and Guidelines Committee of the European Association for Cardio-Thoracic Surgery (EACTS). We review the following topics: evidence for aspirin, clopidogrel and warfarin cessation prior to cardiac surgery; perioperative interventions to reduce bleeding including the use of aprotinin and tranexamic acid; the use of thromboelastography to guide blood product usage; protamine reversal of heparin; the use of factor VIIa to control severe bleeding; anticoagulation after mechanical, tissue valve replacement and mitral valve repair; the use of antiplatelets and clopidogrel after cardiac surgery to improve graft patency and reduce thromboembolic complications and thromboprophylaxis in the postoperative period. This guideline is subject to continuous informal review, and when new evidence becomes available. The formal review date will be at 5 years from publication (September 2013).

Key Words: Evidence-based medicine • Guidelines • Thoracic surgery • Antiplatelet therapy • Anticoagulation therapy