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Coronary Artery Bypass Surgery in Patients Receiving Dual Antiplatelet Therapy and the Impact of Preoperative Vitamin D Levels During COVID-19 Pandemic: An Observational Single Center Study

Year 2023, , 434 - 438, 31.08.2023
https://doi.org/10.54005/geneltip.1281015

Abstract

Background: The COVID-19 pandemic has led to a surge in catheter-based interventions as elective surgeries were postponed. However, there has been a simultaneous rise in emergency CABG surgeries due to stent thrombosis or catheter-related complications. The potential impact of vitamin D on the immune system has also gained attention during the pandemic. We aim to investigate the impact of preoperative dual anti-platelet (DAPT) usage and vitamin D levels of those patients who underwent CABG on postoperative outcomes.
Materials and methods: This retrospective study was conducted between March 23, 2020, and December 30, 2021. The study included 63 patients who underwent elective and emergency CABG while on dual antiplatelet therapy, d vitamin levels were obtained from all the patients preoperatively.
Results: 51 of the 63 patients were males and 12 were females. The mean age was 62.69 ± 8.43 years. 15 patients (24%) were on Clopidogrel and Acetylsalicylic acid (ASA) and 48 patients (76%) were on Ticagrelor and ASA preoperatively. Off-pump CABG was performed in 21 patients (33%). One patient had a stroke (1.6 %). The amount of drainage was significantly higher in patients using Ticagrelor and (ASA) (p=0.015). The mean vitamin D level was 13.94±5.24 ng/ml ranging from 3.38 ng/ml to 24.99 ng/ml, Vitamin D levels were significantly lower in female patients compared to males (p=0.004).
Conclusion: CABG surgery in patients receiving DAPT presents unique challenges and requires careful management to minimize bleeding complications. Additionally, maintaining adequate vitamin D levels preoperatively may improve postoperative outcomes.

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References

  • Mattiuzzi C, Lippi G. Which lessons shall we learn from the 2019 novel coronavirus outbreak? Ann Transl Med 2020; 8: 48–48.
  • WHO characterizes COVID-19 as a pandemic [online] Website https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-asthey- happen [accessed 29 March 2020]. 2020. .
  • Bhatt DL, Cryer BL, Contant CF, Cohen M, Lanas A, Schnitzer TJ et al. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med 2010; 363: 1909–1917.
  • Kulik A, Ruel M, Jneid H, Ferguson TB, Hiratzka LF, Ikonomidis JS et al. Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association. Circulation 2015; 131: 927–964.
  • Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V et al. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost 2020; 18: 1738–1742.
  • O WH. WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data. World Health Organization. 2021; : 1–5.
  • Chatterjee P, Nagi N, Agarwal A, Das B, Banerjee S, Sarkar S et al. The 2019 novel coronavirus disease (COVID-19) pandemic: A review of the current evidence. Indian J Med Res 2020; 151: 147–159.
  • Nepogodiev D, Omar OM, Glasbey JC, Li E, Simoes JFF, Abbott TEF et al. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. British Journal of Surgery 2020; 107: 1440–1449.
  • Gaudino M, Chikwe J, Hameed I, Robinson NB, Fremes SE, Ruel M. Response of cardiac surgery units to COVID-19: An internationally-based quantitative survey. Circulation 2020; 142: 300–302.
  • Sahin I, Okuyan E, Gungor B, Kaya A, Avci II, Biter HI et al. Lower vitamin D level is associated with poor coronary collateral circulation. Scand Cardiovasc J 2014; 48: 278–283.
  • Tekeli Kunt A, Tümer NB, Özışık K, Günaydın S. Preoperative Vitamin D Level Predicts Operative Mortality After Cardiac Surgery. e-Journal of Cardiovascular Medicine 2020; 8: 146–151.
  • Violi F, Pastori D, Cangemi R, Pignatelli P, Loffredo L. Hypercoagulation and Antithrombotic Treatment in Coronavirus 2019: A New Challenge. Thromb Haemost 2020; 120: 949.
  • Schotola H, Bräuer A, Meyer K, Hinz J, Schöndube FA, Bauer M et al. Perioperative outcomes of cardiac surgery patients with ongoing ticagrelor therapy: Boon and bane of a new drug. European Journal of Cardio-thoracic Surgery 2014; 46: 198–205.
Year 2023, , 434 - 438, 31.08.2023
https://doi.org/10.54005/geneltip.1281015

Abstract

Project Number

n/a

References

  • Mattiuzzi C, Lippi G. Which lessons shall we learn from the 2019 novel coronavirus outbreak? Ann Transl Med 2020; 8: 48–48.
  • WHO characterizes COVID-19 as a pandemic [online] Website https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-asthey- happen [accessed 29 March 2020]. 2020. .
  • Bhatt DL, Cryer BL, Contant CF, Cohen M, Lanas A, Schnitzer TJ et al. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med 2010; 363: 1909–1917.
  • Kulik A, Ruel M, Jneid H, Ferguson TB, Hiratzka LF, Ikonomidis JS et al. Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association. Circulation 2015; 131: 927–964.
  • Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V et al. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost 2020; 18: 1738–1742.
  • O WH. WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data. World Health Organization. 2021; : 1–5.
  • Chatterjee P, Nagi N, Agarwal A, Das B, Banerjee S, Sarkar S et al. The 2019 novel coronavirus disease (COVID-19) pandemic: A review of the current evidence. Indian J Med Res 2020; 151: 147–159.
  • Nepogodiev D, Omar OM, Glasbey JC, Li E, Simoes JFF, Abbott TEF et al. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. British Journal of Surgery 2020; 107: 1440–1449.
  • Gaudino M, Chikwe J, Hameed I, Robinson NB, Fremes SE, Ruel M. Response of cardiac surgery units to COVID-19: An internationally-based quantitative survey. Circulation 2020; 142: 300–302.
  • Sahin I, Okuyan E, Gungor B, Kaya A, Avci II, Biter HI et al. Lower vitamin D level is associated with poor coronary collateral circulation. Scand Cardiovasc J 2014; 48: 278–283.
  • Tekeli Kunt A, Tümer NB, Özışık K, Günaydın S. Preoperative Vitamin D Level Predicts Operative Mortality After Cardiac Surgery. e-Journal of Cardiovascular Medicine 2020; 8: 146–151.
  • Violi F, Pastori D, Cangemi R, Pignatelli P, Loffredo L. Hypercoagulation and Antithrombotic Treatment in Coronavirus 2019: A New Challenge. Thromb Haemost 2020; 120: 949.
  • Schotola H, Bräuer A, Meyer K, Hinz J, Schöndube FA, Bauer M et al. Perioperative outcomes of cardiac surgery patients with ongoing ticagrelor therapy: Boon and bane of a new drug. European Journal of Cardio-thoracic Surgery 2014; 46: 198–205.
There are 13 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Article
Authors

Sameh Alagha 0000-0002-7892-5471

Meral Ekim This is me 0000-0002-7146-5935

Project Number n/a
Early Pub Date August 29, 2023
Publication Date August 31, 2023
Submission Date April 11, 2023
Published in Issue Year 2023

Cite

Vancouver Alagha S, Ekim M. Coronary Artery Bypass Surgery in Patients Receiving Dual Antiplatelet Therapy and the Impact of Preoperative Vitamin D Levels During COVID-19 Pandemic: An Observational Single Center Study. Genel Tıp Derg. 2023;33(4):434-8.