CABG-procedures in patients with pretreatment with the GPIIb/IIIa-receptor antagonist tirofiban (Aggrastat©): Modification of perioperative management?

In order to investigate the effects of tirofiban administration in cardiac surgery all patients undergoing coronary artery bypass grafting (CABG) which received this drug preoperatively between 1/2002 and 6/2005 (n = 232) were studied. Three groups regarding the perioperative administration of antifibrinolytic drugs were compared: group A = controls (n = 70), group B = aprotinin (n = 110), group C = tranexamic acid (n = 52) Furthermore we could differ the patients depending on the time when tirofiban was stopped (< 2 h, 2–4 h, > 4 h preoperatively). The postoperative blood loss was significantly higher in all tirofiban-patients (A–C) compared to a group of CABG-patients without tirofiban. The best results concerning blood loss, transfusion of red cell concentrates (rcc), fresh frozen plasma (ffp) and incidence of re-sternotomy could be found in patients with aprotinin. A further significant improvement could be seen in patients who received platelets, intraoperative hemofiltration and in which tirofiban was stopped > 4 h preoperatively. We conclude that by early presurgical discontinuing of tirofiban-therapy and slight modifications of the perioperative management bleeding complications can significantly be reduced.