[HSF] Re: [HSF ] OPCAB pitfall

[A]

Appreciate the pearl one question however I could not figure what TEG stands
for. Please enlighten me. Thanks

Ahmed


-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Donald Ross
Sent: Wednesday, January 31, 2007 1:53 AM
To: OpenHeart-L at lists.hsforum.com
Subject: [HSF] Re: [HSF ] OPCAB pitfall

This is a cautionary tale about a case done for a colleague  who is a  
dedicated opcaber but  has not yet developed a respect for the  
dangers of hypercoagulation.
A routine off pump cabg X3 was done on his service with lima to Lad  
and SVG to Cx,Pda ( T-graft from lima, vein used because radial  
unavailable)
Pre-op TEG was slightly hypercoagulable but this result was ignored  
and all the heparin was reversed and early post-op aspirin given.
Next day the patient looked okay but there was a small troponin leak  
which triggered a re-cath.
This showed complete thrombosis of the SVG which obviously required  
re-op.

Because I have been similarly burnt I use a different protocol which  
so far has been effective.
1. Only reverse half heparin in all cases
2. Give clopidogrel as well as aspirin within 30 min of returning to  
recovery . ( clopidogrel ceased at 6 weeks)
3. If TEG is suspicious don't reverse heparin and give intra-op  
aspirin and clopidogrel

A final observation  is that the SVG is more prone to this annoying  
complication than the IMA. Hopefully the radial is also protected.
Don
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