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Risk factors for re-exploration due to bleeding after coronary artery bypass grafting
Univ Uppsala Hosp, Dept Cardiothorac Surg & Anesthesiol, S-75185 Uppsala, Sweden..
Karolinska Inst, Ctr Pharmacoepidemiol, Clin Epidemiol Unit, Dept Med Solna, Stockholm, Sweden..
Örebro University Hospital. Orebro Univ Hosp, Dept Cardiothorac Surg, Orebro, Sweden..
Karolinska Inst, Ctr Pharmacoepidemiol, Clin Epidemiol Unit, Dept Med Solna, Stockholm, Sweden..
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2012 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, no 1, 39-44 p.Article in journal (Refereed) Published
Abstract [en]

Objective. The study aimed to investigate relevant clinical risk factors for re-exploration due to bleeding after primary coronary artery bypass graft (CABG) surgery, and to evaluate the influence of antiplatelet and antifibrinolytic drugs. Design. Three retrospective analyses were performed on patients who underwent CABG: (1) Logistic regression was used to identify clinical risk factors for re-exploration (n = 3000). (2) A case-control study (n = 228) was used to obtain information on exposure of antithrombotic and hemostatic therapy. (3) Based on exposure to antiplatelet and antifibrinolytic therapy, and odds ratios (ORs) in multivariate logistic models, the proportion of re-explorations attributed to these drugs was calculated. Results. A receiver operating characteristic curve was created for clinical risk factors. The C-index was 0.64, indicating limited ability to predict re-exploration for bleeding. Clopidogrel was the only drug influencing the risk of re-exploration (OR 3.2, 95% CI 1.7-5.9). The harmful effect of clopidogrel was confirmed in multivariate model (OR 4.7, 95% CI 2.2-9.9), and aprotinin had a protective effect of the same magnitude (OR 0.2, 95% CI 0.1-0.6). Conclusions. Clopidogrel is an essential risk factor for re-exploration due to bleeding, and attributable to at least one-quarter of surveyed cases. Aside from pharmaceuticals, there are no strong clinical risk factors.

Place, publisher, year, edition, pages
INFORMA HEALTHCARE , 2012. Vol. 46, no 1, 39-44 p.
Keyword [en]
cardiac surgery, bleeding, reoperation
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-58299DOI: 10.3109/14017431.2011.629004ISI: 000298748100006PubMedID: 21970388OAI: oai:DiVA.org:oru-58299DiVA: diva2:1115575
Available from: 2017-06-27 Created: 2017-06-27 Last updated: 2017-06-27

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