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.

J Am Heart Assoc 2019; Oct 8(19):e013246

This is the (so far) largest study investigating the incidence and outcomes of venous thromboembolism (VTE) in patients undergoing coronary artery bypass grafting (CABG). For the present study, the authors collected data from the National Inpatient Sample, which is the largest all-payer inpatient database in the United States, from 2013 to 2014. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used for patient identification. Patients who received concomitant valvular procedures were excluded. Patients with acute deep vein thrombosis and/or pulmonary embolism were identified using the respective ICD-9-CM codes. Patients with superficial vein thrombosis were not included in the final analysis.

Of the included 331950 CABG hospitalizations (20% off-pump CABG procedures), 1.3% had a concomitant diagnosis of VTE with pulmonary embolism and 0.9% with deep vein thrombosis only. Patients with VTE were older and more likely to have a history of previous VTE, coagulopathy, obesity, chronic pulmonary disease, heart failure or renal failure. Off-pump CABG was not associated with the occurrence of VTE.

The occurrence of VTE was associated with increased in-hospital mortality, acute kidney injury, acute kidney injury requiring dialysis, acute respiratory failure, stroke and bleeding.

Additionally, VTE was related to longer length of stay and higher costs.

In summary, this large analysis highlights the risk of VTE among patients undergoing CABG: despite its rare occurrence, VTE after CABG is associated with significant morbidity and mortality. Further studies are needed to appropriately select CABG- patients at risk of VTE and to prospectively evaluate optimal VTE prophylaxis strategies.