Association of acute venous thromboembolism with in-hospital outcomes of coronary artery bypass graft surgery.

Association of acute venous thromboembolism with in-hospital outcomes of coronary artery bypass graft surgery.

Panhwar MS; Ginwalla M; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Sabik JF 3rd

Journal of the American Heart Association

2019

2019-10

Background While venous thromboembolism (VTE) prophylaxis is a strong recommendation after most surgeries, it is controversial in cardiac surgeries such as coronary artery bypass grafting (CABG), because of perceived low VTE incidence and increased bleeding risk. Prior studies may not have been adequately powered to study outcomes of VTE in this population. We sought to investigate the postoperative incidence and outcomes of CABG patients using a large national inpatient database. Methods and Results We utilized the 2013 to 2014 National Inpatient Sample to identify all patients >18 years of age who underwent CABG (without concomitant valvular procedures), and had VTE during the hospital stay. We then compared clinically relevant outcomes in patients with and without VTE. We identified 331 950 CABG procedures. Of these, 1.3% (n=4205) had VTE. Patients with VTE were more likely to be older (mean 67.2±10.4 years versus 65.2±10.4 years, P<0.001). VTE was associated with higher incidence of inpatient mortality (6.8% versus 1.7%; adjusted odds ratio 1.92 [95% CI 1.40-2.65]; P<0.001) and complications. VTE was also associated with higher cost (mean±SE $81 995±$923 versus $48 909±$55) and longer length of stay (mean±SE 17.06±0.16 days versus 8.52±0.01 days). Conclusions Our analysis of >330 000 CABG procedures suggests that while postoperative VTE after CABG is rare, it is associated with increased morbidity and mortality. Randomized controlled trials are needed to identify optimal strategies for VTE prophylaxis in these patients.

venous thrombosis; coronary artery bypass; coronary artery bypass graft surgery; venous thromboembolism

PMID: 31533551

Copyright © 2019. Published by Elsevier Inc.

journalArticle

e013246

19

8

2047-9980

NEOMED College of Medicine

Department of Internal Medicine

June2020SubmittedList

Cleveland Clinic Akron General Hospital