Journal of cardiac surgery
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The use of intravenous glycoprotein (GP) IIb/IIIa platelet receptor antagonists in the management of patients with acute coronary syndrome or those undergoing percutaneous coronary intervention (PCI) has become increasingly common in recent years. There are three GP IIb/IIIa receptor antagonists currently available for clinical use. Patients on GP IIb/IIIa receptor antagonists who require emergency surgical revascularization may be at increased risk for excessive peri- and postoperative bleeding. ⋯ However, platelet transfusion has been shown to successfully reduce the incidence of these complications. The current evidence therefore indicates that, with appropriate measures, urgent surgical revascularization can be safely performed in patients who have received a GP IIb/IIIa receptor antagonist with little added risk. The benefits of these agents in the treatment of patients with an acute coronary syndrome or undergoing PCI are not obviated by the need for emergency bypass surgery.
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Dual objectives at operation are technical success and absence of iatrogenic injury due to inadequate myocardial protection. We enter a new millennium, and the spectrum of surgical procedures used to correct abnormal structure is expanding. ⋯ Simultaneously, our patients have increased vulnerability to injury, so that growth is needed to advance our methods of protection, in the same way as we learn new operative techniques. This manuscript deals both with evolution of current methods and recognition of newer methods of protection, so that the dual relationship between protection and procedures will not separate.