University of Oulu

Sorosh Khodabandeh, Fausto Biancari, Eeva-Maija Kinnunen, Giovanni Mariscalco, Juhani Airaksinen, Riccardo Gherli, Giuseppe Gatti, Till Demal, Francesco Onorati, Giuseppe Faggian, Marisa De Feo, Giuseppe Santarpino, Antonino S. Rubino, Daniele Maselli, Antonio Salsano, Francesco Nicolini, Marco Zanobini, Vito G. Ruggieri, Karl Bounader, Andrea Perrotti, Magnus Dalén, Perioperative Bleeding in Patients With Acute Coronary Syndrome Treated With Fondaparinux Versus Low-Molecular-Weight Heparin Before Coronary Artery Bypass Grafting, The American Journal of Cardiology, Volume 123, Issue 4, 2019, Pages 565-570, ISSN 0002-9149,

Perioperative bleeding in patients with acute coronary syndrome treated with fondaparinux versus low-molecular-weight heparin before coronary artery bypass grafting

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Author: Khodabandeh, Sorosh1,2; Biancari, Fausto3,4,5; Kinnunen, Eeva-Maija5;
Organizations: 1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
2Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden
3Heart Center, Turku University Hospital, University of Turku, Turku, Finland
4Department of Surgery, University of Turku, Turku, Finland
5Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
6Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
7Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
8Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
9Hamburg University Heart Center, Hamburg, Germany
10Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
11Department of Cardiothoracic Sciences, University of Caserta, Caserta, Italy
12Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany and Città di Lecce Hospital GVM Care and Research, Lecce, Italy
13Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Napoli, Italy
14Centro Clinico-Diagnostico “G.B. Morgagni”, Centro Cuore, Pedara, Italy
15Division of Cardiac Surgery, University of Genoa, Genoa, Italy
16Division of Cardiac Surgery, University of Parma, Parma, Italy
17Department of Cardiac Surgery, Centro Cardiologico—Fondazione Monzino IRCCS, University of Milan, Milan, Italy
18Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
19Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
20Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
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Language: English
Published: Elsevier, 2019
Publish Date: 2019-11-24


The perioperative bleeding risk in patients receiving fondaparinux versus low-molecular weight heparin before coronary artery bypass grafting has not been reported. We evaluated perioperative coronary artery bypass grafting -related bleeding in patients with acute coronary syndrome preoperatively treated with fondaparinux or low-molecular weight heparin. All patients with acute coronary syndrome from the prospective, European multicenter registry on Coronary Artery Bypass Grafting (E-CABG) preoperatively treated with fondaparinux or lowmolecular weight heparin undergoing isolated primary CABG were eligible. The primary outcome measure was severe or massive bleeding defined according to the Universal Definition of Perioperative Bleeding stratified by P2Y12 inhibitor discontinuation. Secondary outcome measures included three additional definitions of major bleeding used in cardiac surgery trials. Propensity score matching was performed to adjust for differences in pre- and perioperative covariates. 1525 patients were included, of whom 276 (18.1%) received fondaparinux and 1249 (81.9%) low-molecular weight heparin preoperatively. In the propensity score-matched cohort (245 pairs), the risk of major bleeding according to the Universal Definition of Perioperative Bleeding severe or massive bleeding (11.8 versus 9.0%, p = 0.285) and the three other major bleeding definitions was similar between the fondaparinux and low-molecular weight heparin cohorts. In conclusion, preoperative treatment with fondaparinux compared to low-molecular weight heparin was associated with similar incidence of perioperative bleeding in patients with acute coronary syndrome undergoing coronary artery bypass grafting.

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Series: The American journal of cardiology
ISSN: 0002-9149
ISSN-E: 1879-1913
ISSN-L: 0002-9149
Volume: 123
Issue: 4
Pages: 565 - 570
DOI: 10.1016/j.amjcard.2018.11.028
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Magnus Dalén was financially supported by a research grant from Karolinska Institutet (grant number 2018-01278).
Copyright information: © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license