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Bleeding Following Coronary Surgery After Preoperative Low-Molecular-Weight Heparin

Department of Cardiothoracic Surgery
¹ Department of Anaesthesia, St Elisabeth Heart Centre, Trondheim University Hospital, Trondheim, Norway

For reprint information contact: Ulf Myhre, MD Tel: 46 31 342 1000 Fax: 46 31 417 991 Email: ulf_myhre{at}yahoo.com Department of Cardiothoracic Surgery, Sahlgrenska Hospital, Gothenburg 413 45, Sweden.

Low-molecular-weight heparin and acetyl salicylic acid have become an established treatment for unstable angina. A retrospective study on our database of one year was carried out to see what impact preoperative low-molecular-weight heparin versus none had on the postoperative course of 473 patients having coronary surgery exclusively. Apart from the fact that the low-molecular-weight heparin patients had a higher New York Heart Association classification and marginally more grafts, longer bypass and cross-clamp time, the preoperative characteristics and surgery of the two groups were similar. The low-molecular-weight heparin group had twice as many (9.7% versus 4.7%) re-operations for bleeding, 46% versus 26% had blood transfusion and 22.3% versus 12.6% plasma transfusion. The postoperative outcome was otherwise similar. Preoperative treatment of unstable angina with low-molecular-weight heparin carries a definite risk of postoperative bleeding. Although this study did not reveal any serious consequences, bleeding, transfusions and re-operations are associated with infections, wound healing problems and death. The indications and length of treatment with low-molecular-weight heparin in unstable angina patients have to be appropriate and the perioperative management of these patients has to address the bleeding tendency.

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