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| __NOTOC__
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| {{Coronary artery bypass surgery}}
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| {{CMG}}; {{AOEIC}} {{VK}}
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| ==ACCF/AHA Guidelines for Perioperative Bleeding/Transfusion<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>==
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| {{cquote|
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| ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
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| '''1.''' Lysine analogues are useful intraoperatively and postoperatively in patients undergoing on-pump CABG to reduce perioperative blood loss and transfusion requirements.<ref name="pmid18480196">{{cite journal |author=Fergusson DA, Hébert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, Teoh K, Duke PC, Arellano R, Blajchman MA, Bussières JS, Côté D, Karski J, Martineau R, Robblee JA, Rodger M, Wells G, Clinch J, Pretorius R |title=A comparison of aprotinin and lysine analogues in high-risk cardiac surgery |journal=[[The New England Journal of Medicine]] |volume=358 |issue=22 |pages=2319–31 |year=2008 |month=May |pmid=18480196 |doi=10.1056/NEJMoa0802395 |url=http://dx.doi.org/10.1056/NEJMoa0802395 |accessdate=2011-12-19}}</ref><ref name="pmid19535691">{{cite journal |author=Greilich PE, Jessen ME, Satyanarayana N, Whitten CW, Nuttall GA, Beckham JM, Wall MH, Butterworth JF |title=The effect of epsilon-aminocaproic acid and aprotinin on fibrinolysis and blood loss in patients undergoing primary, isolated coronary artery bypass surgery: a randomized, double-blind, placebo-controlled, noninferiority trial |journal=[[Anesthesia and Analgesia]] |volume=109 |issue=1 |pages=15–24 |year=2009 |month=July |pmid=19535691 |doi=10.1213/ane.0b013e3181a40b5d |url=http://www.anesthesia-analgesia.org/cgi/pmidlookup?view=long&pmid=19535691 |accessdate=2011-12-19}}</ref><ref name="pmid16427545">{{cite journal |author=Kikura M, Levy JH, Tanaka KA, Ramsay JG |title=A double-blind, placebo-controlled trial of epsilon-aminocaproic acid for reducing blood loss in coronary artery bypass grafting surgery |journal=[[Journal of the American College of Surgeons]] |volume=202 |issue=2 |pages=216–22; quiz A44–5 |year=2006 |month=February |pmid=16427545 |doi=10.1016/j.jamcollsurg.2005.10.001 |url=http://linkinghub.elsevier.com/retrieve/pii/S1072-7515(05)01598-X |accessdate=2011-12-19}}</ref><ref name="pmid17664199">{{cite journal |author=Mehr-Aein A, Sadeghi M, Madani-civi M |title=Does tranexamic acid reduce blood loss in off-pump coronary artery bypass? |journal=[[Asian Cardiovascular & Thoracic Annals]] |volume=15 |issue=4 |pages=285–9 |year=2007 |month=August |pmid=17664199 |doi= |url=http://asianannals.ctsnetjournals.org/cgi/pmidlookup?view=long&pmid=17664199 |accessdate=2011-12-19}}</ref><ref name="pmid17244923">{{cite journal |author=Mehr-Aein A, Davoodi S, Madani-Civi M |title=Effects of tranexamic acid and autotransfusion in coronary artery bypass |journal=[[Asian Cardiovascular & Thoracic Annals]] |volume=15 |issue=1 |pages=49–53 |year=2007 |month=January |pmid=17244923 |doi= |url=http://asianannals.ctsnetjournals.org/cgi/pmidlookup?view=long&pmid=17244923 |accessdate=2011-12-19}}</ref><ref name="pmid16935098">{{cite journal |author=Murphy GJ, Mango E, Lucchetti V, Battaglia F, Catapano D, Rogers CA, Angelini GD |title=A randomized trial of tranexamic acid in combination with cell salvage plus a meta-analysis of randomized trials evaluating tranexamic acid in off-pump coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=132 |issue=3 |pages=475–80, 480.e1–8 |year=2006 |month=September |pmid=16935098 |doi=10.1016/j.jtcvs.2006.01.064 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(06)00861-0 |accessdate=2011-12-19}}</ref><ref name="pmid16400465">{{cite journal |author=Santos AT, Kalil RA, Bauemann C, Pereira JB, Nesralla IA |title=A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting |journal=[[Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Médicas E Biológicas / Sociedade Brasileira De Biofísica ... [Et Al.]]] |volume=39 |issue=1 |pages=63–9 |year=2006 |month=January |pmid=16400465 |doi=/S0100-879X2006000100007 |url=http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2006000100007&lng=en&nrm=iso&tlng=en |accessdate=2011-12-19}}</ref><ref name="pmid19103500">{{cite journal |author=Taghaddomi RJ, Mirzaee A, Attar AS, Shirdel A |title=Tranexamic acid reduces blood loss in off-pump coronary artery bypass surgery |journal=[[Journal of Cardiothoracic and Vascular Anesthesia]] |volume=23 |issue=3 |pages=312–5 |year=2009 |month=June |pmid=19103500 |doi=10.1053/j.jvca.2008.09.018 |url=http://linkinghub.elsevier.com/retrieve/pii/S1053-0770(08)00299-1 |accessdate=2011-12-19}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
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| '''2.''' A multimodal approach with transfusion algorithms, point-of-care testing, and a focused blood conservation strategy should be used to limit the number of transfusions.<ref name="pmid7940165">{{cite journal |author=Paone G, Spencer T, Silverman NA |title=Blood conservation in coronary artery surgery |journal=[[Surgery]] |volume=116 |issue=4 |pages=672–7; discussion 677–8 |year=1994 |month=October |pmid=7940165 |doi= |url= |accessdate=2011-12-19}}</ref><ref name="pmid11388527">{{cite journal |author=Nuttall GA, Oliver WC, Santrach PJ, Bryant S, Dearani JA, Schaff HV, Ereth MH |title=Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass |journal=[[Anesthesiology]] |volume=94 |issue=5 |pages=773–81; discussion 5A–6A |year=2001 |month=May |pmid=11388527 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0003-3022&volume=94&issue=5&spage=773 |accessdate=2011-12-19}}</ref><ref name="pmid11573637">{{cite journal |author=Royston D, von Kier S |title=Reduced haemostatic factor transfusion using heparinase-modified thrombelastography during cardiopulmonary bypass |journal=[[British Journal of Anaesthesia]] |volume=86 |issue=4 |pages=575–8 |year=2001 |month=April |pmid=11573637 |doi= |url=http://bja.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=11573637 |accessdate=2011-12-19}}</ref><ref name="pmid14722166">{{cite journal |author=Avidan MS, Alcock EL, Da Fonseca J, Ponte J, Desai JB, Despotis GJ, Hunt BJ |title=Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery |journal=[[British Journal of Anaesthesia]] |volume=92 |issue=2 |pages=178–86 |year=2004 |month=February |pmid=14722166 |doi= |url=http://bja.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=14722166 |accessdate=2011-12-19}}</ref><ref name="pmid8178325">{{cite journal |author=Despotis GJ, Grishaber JE, Goodnough LT |title=The effect of an intraoperative treatment algorithm on physicians' transfusion practice in cardiac surgery |journal=[[Transfusion]] |volume=34 |issue=4 |pages=290–6 |year=1994 |month=April |pmid=8178325 |doi= |url= |accessdate=2011-12-19}}</ref><ref name="pmid9972747">{{cite journal |author=Shore-Lesserson L, Manspeizer HE, DePerio M, Francis S, Vela-Cantos F, Ergin MA |title=Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery |journal=[[Anesthesia and Analgesia]] |volume=88 |issue=2 |pages=312–9 |year=1999 |month=February |pmid=9972747 |doi= |url=http://www.anesthesia-analgesia.org/cgi/pmidlookup?view=long&pmid=9972747 |accessdate=2011-12-19}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
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| '''3.''' In patients taking [[thienopyridine]]s ([[clopidogrel]] or [[prasugrel]]) or [[ticagrelor]] in whom elective CABG is planned, clopidogrel and ticagrelor should be withheld for at least 5 days<ref name="pmid19007688">{{cite journal |author=Berger JS, Frye CB, Harshaw Q, Edwards FH, Steinhubl SR, Becker RC |title=Impact of clopidogrel in patients with acute coronary syndromes requiring coronary artery bypass surgery: a multicenter analysis |journal=[[Journal of the American College of Cardiology]] |volume=52 |issue=21 |pages=1693–701 |year=2008 |month=November |pmid=19007688 |doi=10.1016/j.jacc.2008.08.031 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)02926-4 |accessdate=2011-12-19}}</ref><ref name="pmid21194870">{{cite journal |author=Held C, Asenblad N, Bassand JP, Becker RC, Cannon CP, Claeys MJ, Harrington RA, Horrow J, Husted S, James SK, Mahaffey KW, Nicolau JC, Scirica BM, Storey RF, Vintila M, Ycas J, Wallentin L |title=Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery: results from the PLATO (Platelet Inhibition and Patient Outcomes) trial |journal=[[Journal of the American College of Cardiology]] |volume=57 |issue=6 |pages=672–84 |year=2011 |month=February |pmid=21194870 |doi=10.1016/j.jacc.2010.10.029 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)04832-1 |accessdate=2011-12-19}}</ref><ref name="pmid19616440">{{cite journal |author=Firanescu CE, Martens EJ, Schönberger JP, Soliman Hamad MA, van Straten AH |title=Postoperative blood loss in patients undergoing coronary artery bypass surgery after preoperative treatment with clopidogrel. A prospective randomised controlled study |journal=[[European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery]] |volume=36 |issue=5 |pages=856–62 |year=2009 |month=November |pmid=19616440 |doi=10.1016/j.ejcts.2009.05.032 |url=http://linkinghub.elsevier.com/retrieve/pii/S1010-7940(09)00564-8 |accessdate=2011-12-19}}</ref><ref name="pmid20103308">{{cite journal |author=Herman CR, Buth KJ, Kent BA, Hirsch GM |title=Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery |journal=[[The Annals of Thoracic Surgery]] |volume=89 |issue=2 |pages=397–402 |year=2010 |month=February |pmid=20103308 |doi=10.1016/j.athoracsur.2009.10.051 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(09)02162-6 |accessdate=2011-12-19}}</ref><ref name="pmid19061702">{{cite journal |author=Kim JH, Newby LK, Clare RM, Shaw LK, Lodge AJ, Smith PK, Jolicoeur EM, Rao SV, Becker RC, Mark DB, Granger CB |title=Clopidogrel use and bleeding after coronary artery bypass graft surgery |journal=[[American Heart Journal]] |volume=156 |issue=5 |pages=886–92 |year=2008 |month=November |pmid=19061702 |doi=10.1016/j.ahj.2008.06.034 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(08)00556-5 |accessdate=2011-12-19}}</ref><ref name="pmid15511426">{{cite journal |author=Chu MW, Wilson SR, Novick RJ, Stitt LW, Quantz MA |title=Does clopidogrel increase blood loss following coronary artery bypass surgery? |journal=[[The Annals of Thoracic Surgery]] |volume=78 |issue=5 |pages=1536–41 |year=2004 |month=November |pmid=15511426 |doi=10.1016/j.athoracsur.2004.03.028 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003497504006472 |accessdate=2011-12-19}}</ref><ref name="pmid15200986">{{cite journal |author=Englberger L, Faeh B, Berdat PA, Eberli F, Meier B, Carrel T |title=Impact of clopidogrel in coronary artery bypass grafting |journal=[[European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery]] |volume=26 |issue=1 |pages=96–101 |year=2004 |month=July |pmid=15200986 |doi=10.1016/j.ejcts.2004.03.030 |url=http://linkinghub.elsevier.com/retrieve/pii/S1010794004002441 |accessdate=2011-12-19}}</ref><ref name="pmid16567570">{{cite journal |author=Kapetanakis EI, Medlam DA, Petro KR, Haile E, Hill PC, Dullum MK, Bafi AS, Boyce SW, Corso PJ |title=Effect of clopidogrel premedication in off-pump cardiac surgery: are we forfeiting the benefits of reduced hemorrhagic sequelae? |journal=[[Circulation]] |volume=113 |issue=13 |pages=1667–74 |year=2006 |month=April |pmid=16567570 |doi=10.1161/CIRCULATIONAHA.105.571828 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16567570 |accessdate=2011-12-19}}</ref><ref name="pmid18455412">{{cite journal |author=Maltais S, Perrault LP, Do QB |title=Effect of clopidogrel on bleeding and transfusions after off-pump coronary artery bypass graft surgery: impact of discontinuation prior to surgery |journal=[[European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery]] |volume=34 |issue=1 |pages=127–31 |year=2008 |month=July |pmid=18455412 |doi=10.1016/j.ejcts.2008.03.052 |url=http://linkinghub.elsevier.com/retrieve/pii/S1010-7940(08)00366-7 |accessdate=2011-12-19}}</ref><ref name="pmid11519503">{{cite journal |author=Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK |title=Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation |journal=[[The New England Journal of Medicine]] |volume=345 |issue=7 |pages=494–502 |year=2001 |month=August |pmid=11519503 |doi=10.1056/NEJMoa010746 |url=http://dx.doi.org/10.1056/NEJMoa010746 |accessdate=2011-12-19}}</ref><ref name="pmid19185143">{{cite journal |author=Vaccarino GN, Thierer J, Albertal M, Vrancic M, Piccinini F, Benzadón M, Raich H, Navia DO |title=Impact of preoperative clopidogrel in off pump coronary artery bypass surgery: a propensity score analysis |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=137 |issue=2 |pages=309–13 |year=2009 |month=February |pmid=19185143 |doi=10.1016/j.jtcvs.2008.08.002 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(08)01300-7 |accessdate=2011-12-19}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' and prasugrel for at least 7 days<ref name="pmid17982182">{{cite journal |author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM |title=Prasugrel versus clopidogrel in patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=20 |pages=2001–15 |year=2007 |month=November |pmid=17982182 |doi=10.1056/NEJMoa0706482 |url=http://dx.doi.org/10.1056/NEJMoa0706482 |accessdate=2011-12-19}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' before surgery.
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| '''4.''' It is recommended that surgery be delayed after the administration of [[streptokinase]], [[urokinase]], and [[tissue plasminogen activator|tissue-type plasminogen activators]] until hemostatic capacity is restored, if possible. The timing of recommended delay should be guided by the pharmacodynamic half-life of the involved agent. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
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| '''5.''' [[Tirofiban]] or [[eptifibatide]] should be discontinued at least 2 to 4 hours before CABG and [[abciximab]] at least 12 hours before CABG.<ref name="pmid11726894">{{cite journal |author=Bizzarri F, Scolletta S, Tucci E, Lucidi M, Davoli G, Toscano T, Neri E, Muzzi L, Frati G |title=Perioperative use of tirofiban hydrochloride (Aggrastat) does not increase surgical bleeding after emergency or urgent coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=122 |issue=6 |pages=1181–5 |year=2001 |month=December |pmid=11726894 |doi=10.1067/mtc.2001.117838 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(01)33968-5 |accessdate=2011-12-19}}</ref><ref name="pmid11016325">{{cite journal |author=Dyke CM, Bhatia D, Lorenz TJ, Marso SP, Tardiff BE, Hogeboom C, Harrington RA |title=Immediate coronary artery bypass surgery after platelet inhibition with eptifibatide: results from PURSUIT. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrelin Therapy |journal=[[The Annals of Thoracic Surgery]] |volume=70 |issue=3 |pages=866–71; discussion 871–2 |year=2000 |month=September |pmid=11016325 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0003497500016544 |accessdate=2011-12-19}}</ref><ref name="pmid10969673">{{cite journal |author=Lincoff AM, LeNarz LA, Despotis GJ, Smith PK, Booth JE, Raymond RE, Sapp SK, Cabot CF, Tcheng JE, Califf RM, Effron MB, Topol EJ |title=Abciximab and bleeding during coronary surgery: results from the EPILOG and EPISTENT trials. Improve Long-term Outcome with abciximab GP IIb/IIIa blockade. Evaluation of Platelet IIb/IIIa Inhibition in STENTing |journal=[[The Annals of Thoracic Surgery]] |volume=70 |issue=2 |pages=516–26 |year=2000 |month=August |pmid=10969673 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0003497500013436 |accessdate=2011-12-19}}</ref><ref name="pmid16935098">{{cite journal |author=Murphy GJ, Mango E, Lucchetti V, Battaglia F, Catapano D, Rogers CA, Angelini GD |title=A randomized trial of tranexamic acid in combination with cell salvage plus a meta-analysis of randomized trials evaluating tranexamic acid in off-pump coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=132 |issue=3 |pages=475–80, 480.e1–8 |year=2006 |month=September |pmid=16935098 |doi=10.1016/j.jtcvs.2006.01.064 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(06)00861-0 |accessdate=2011-12-19}}</ref><ref name="pmid16400465">{{cite journal |author=Santos AT, Kalil RA, Bauemann C, Pereira JB, Nesralla IA |title=A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting |journal=[[Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Médicas E Biológicas / Sociedade Brasileira De Biofísica ... [Et Al.]]] |volume=39 |issue=1 |pages=63–9 |year=2006 |month=January |pmid=16400465 |doi=/S0100-879X2006000100007 |url=http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2006000100007&lng=en&nrm=iso&tlng=en |accessdate=2011-12-19}}</ref><ref name="pmid17339186">{{cite journal |author=Renda G, Di Pillo R, D'Alleva A, Sciartilli A, Zimarino M, De Candia E, Landolfi R, Di Giammarco G, Calafiore A, De Caterina R |title=Surgical bleeding after pre-operative unfractionated heparin and low molecular weight heparin for coronary bypass surgery |journal=[[Haematologica]] |volume=92 |issue=3 |pages=366–73 |year=2007 |month=March |pmid=17339186 |doi= |url=http://www.haematologica.org/cgi/pmidlookup?view=long&pmid=17339186 |accessdate=2011-12-19}}</ref><ref name="pmid15747262">{{cite journal |author=McDonald SB, Renna M, Spitznagel EL, Avidan M, Hogue CW, Moon MR, Barzilai B, Saleem R, McDonald JM, Despotis GJ |title=Preoperative use of enoxaparin increases the risk of postoperative bleeding and re-exploration in cardiac surgery patients |journal=[[Journal of Cardiothoracic and Vascular Anesthesia]] |volume=19 |issue=1 |pages=4–10 |year=2005 |month=February |pmid=15747262 |doi=10.1053/j.jvca.2004.11.002 |url=http://linkinghub.elsevier.com/retrieve/pii/S1053077004002733 |accessdate=2011-12-19}}</ref><ref name="pmid12354703">{{cite journal |author=Jones HU, Muhlestein JB, Jones KW, Bair TL, Lavasani F, Sohrevardi M, Horne BD, Doty D, Lappe DL |title=Preoperative use of enoxaparin compared with unfractionated heparin increases the incidence of re-exploration for postoperative bleeding after open-heart surgery in patients who present with an acute coronary syndrome: clinical investigation and reports |journal=[[Circulation]] |volume=106 |issue=12 Suppl 1 |pages=I19–22 |year=2002 |month=September |pmid=12354703 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12354703 |accessdate=2011-12-19}}</ref><ref name="pmid12842525">{{cite journal |author=Kincaid EH, Monroe ML, Saliba DL, Kon ND, Byerly WG, Reichert MG |title=Effects of preoperative enoxaparin versus unfractionated heparin on bleeding indices in patients undergoing coronary artery bypass grafting |journal=[[The Annals of Thoracic Surgery]] |volume=76 |issue=1 |pages=124–8; discussion 128 |year=2003 |month=July |pmid=12842525 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0003497503001905 |accessdate=2011-12-19}}</ref><ref name="pmid14688699">{{cite journal |author=Medalion B, Frenkel G, Patachenko P, Hauptman E, Sasson L, Schachner A |title=Preoperative use of enoxaparin is not a risk factor for postoperative bleeding after coronary artery bypass surgery |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=126 |issue=6 |pages=1875–9 |year=2003 |month=December |pmid=14688699 |doi=10.1016/S0022 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303013242 |accessdate=2011-12-19}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
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| ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
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| '''1.''' It is reasonable to consider off-pump CABG to reduce perioperative bleeding and allogeneic blood transfusion.<ref name="pmid14702424">{{cite journal |author=Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, Collins P, Wang D, Sigwart U, Pepper J |title=A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery |journal=[[The New England Journal of Medicine]] |volume=350 |issue=1 |pages=21–8 |year=2004 |month=January |pmid=14702424 |doi=10.1056/NEJMoa031282 |url=http://dx.doi.org/10.1056/NEJMoa031282 |accessdate=2011-12-19}}</ref><ref name="pmid11955537">{{cite journal |author=Angelini GD, Taylor FC, Reeves BC, Ascione R |title=Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials |journal=[[Lancet]] |volume=359 |issue=9313 |pages=1194–9 |year=2002 |month=April |pmid=11955537 |doi=10.1016/S0140-6736(02)08216-8 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(02)08216-8 |accessdate=2011-12-19}}</ref><ref name="pmid15618803">{{cite journal |author=Cheng DC, Bainbridge D, Martin JE, Novick RJ |title=Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials |journal=[[Anesthesiology]] |volume=102 |issue=1 |pages=188–203 |year=2005 |month=January |pmid=15618803 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0003-3022&volume=102&issue=1&spage=188 |accessdate=2011-12-19}}</ref><ref name="pmid11216739">{{cite journal |author=Czerny M, Baumer H, Kilo J, Zuckermann A, Grubhofer G, Chevtchik O, Wolner E, Grimm M |title=Complete revascularization in coronary artery bypass grafting with and without cardiopulmonary bypass |journal=[[The Annals of Thoracic Surgery]] |volume=71 |issue=1 |pages=165–9 |year=2001 |month=January |pmid=11216739 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(00)02230-X |accessdate=2011-12-19}}</ref><ref name="pmid12698142">{{cite journal |author=Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, Leimbach M, Huber P, Garas S, Sammons BH, McCall SA, Petersen RJ, Bailey DE, Chu H, Mahoney EM, Weintraub WS, Guyton RA |title=Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=4 |pages=797–808 |year=2003 |month=April |pmid=12698142 |doi=10.1067/mtc.2003.324 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303000047 |accessdate=2011-12-19}}</ref><ref name="pmid16426345">{{cite journal |author=Raja SG, Dreyfus GD |title=Impact of off-pump coronary artery bypass surgery on postoperative bleeding: current best available evidence |journal=[[Journal of Cardiac Surgery]] |volume=21 |issue=1 |pages=35–41; discussion 42–3 |year=2006 |pmid=16426345 |doi=10.1111/j.1540-8191.2006.00164.x |url=http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0886-0440&date=2006&volume=21&issue=1&spage=35 |accessdate=2011-12-19}}</ref><ref name="pmid11591611">{{cite journal |author=van Dijk D, Nierich AP, Jansen EW, Nathoe HM, Suyker WJ, Diephuis JC, van Boven WJ, Borst C, Buskens E, Grobbee DE, Robles De Medina EO, de Jaegere PP |title=Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study |journal=[[Circulation]] |volume=104 |issue=15 |pages=1761–6 |year=2001 |month=October |pmid=11591611 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11591611 |accessdate=2011-12-19}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''}}
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| ==Guidelines Resources==
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| *2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>
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| ==References==
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| {{reflist|2}}
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| {{WH}}
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| {{WS}}
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| [[Category:Cardiac surgery]]
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| [[Category:Cardiology]]
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| [[Category:Surgery]]
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| [[Category:Surgical procedures]]
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| [[Category:Up-To-Date]]
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| [[Category:Up-To-Date cardiology]]
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