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Does Dual Antiplatelet Therapy Affect Blood Loss and Transfusion Requirements in Robotic-Assisted Coronary Artery Surgery?

Hemli, Jonathan M. MD, MBBS, FRACS; Darla, Lincoln S. MD; Panetta, Christopher R. RPA-C; Jennings, Joan RN; Subramanian, Valavanur A. MD; Patel, Nirav C. MD

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: November/December 2012 - Volume 7 - Issue 6 - p 399–402
doi: 10.1097/IMI.0b013e3182851779
Original Articles

Objective Patients who present for coronary surgery often receive preoperative dual antiplatelet therapy with aspirin and a thienopyridine derivative (clopidogrel or prasugrel), especially after a recent acute coronary syndrome. Studies have shown that patients on aspirin and clopidogrel are at increased risk for perioperative bleeding and related events. We sought to examine the impact of dual antiplatelet therapy on bleeding and transfusion requirements in patients undergoing robotic-assisted minimally invasive coronary artery bypass grafting.

Methods From January 2010 to November 2011, a total of 110 patients underwent robotic-assisted off-pump coronary surgery at our institution. All patients underwent robotic-assisted harvest of the left internal mammary artery from the chest wall. Some patients then underwent direct coronary anastomosis to the left anterior descending coronary artery via a left minithoracotomy, whereas others had a complete robotic endoscopic procedure within the closed chest. The patients were divided into two groups for outcome analysis on the basis of preoperative antiplatelet therapy: group 1 (either aspirin alone or no antiplatelet agents at all; n = 53) and group 2 (aspirin plus clopidogrel or prasugrel; n = 57).

Results Perioperative chest tube drainage was not significantly different between the patient groups, irrespective of the preoperative antiplatelet agents used. Transfusion requirements and other morbidities were also similar in both groups of patients.

Conclusions Preoperative dual antiplatelet therapy does not result in significantly increased bleeding or perioperative transfusion requirements. If clinically indicated, it is reasonable to continue preoperative combination antiplatelet therapy in patients undergoing robotic-assisted coronary surgery.

From the Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY USA.

Accepted for publication August 29, 2012.

Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, May 30 – June 2, 2012, Los Angeles, CA USA.

Disclosure: The authors declare no conflict of interest.

Address correspondence and reprint requests to Jonathan M. Hemli, MD, MBBS, FRACS, Department of Cardiothoracic Surgery, Lenox Hill Hospital, 130 East 77th St, 4th Floor, New York, NY 10075 USA. Email:

Copyright © 2012 by the International Society for Minimally Invasive Cardiothoracic Surgery. Unauthorized reproduction of this article is prohibited.