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

Yıl 2023, Cilt: 33 Sayı: 4, 434 - 438, 31.08.2023

Sameh Alagha Meral Ekim

https://doi.org/10.54005/geneltip.1281015

Öz

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.

Anahtar Kelimeler

COVID-19, Coronary Artery Disease, Dual Anti-platelet Therapy.

Destekleyen Kurum

n/a

Proje Numarası

n/a

Teşekkür

n/a

Kaynakça

• 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.