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Pulmonary Embolism Following Coronary Artery Bypass Grafting Surgery

Sarah A. Spinler, Pharm.D., FCCP
October 2004

Review: Goldhaber SZ, Schoepf UJ. Pulmonary embolism after coronary artery bypass grafting. Circulation. 2004 Jun 8;109(22):2712-5.

In his recent review article, Dr. Samuel Z. Goldhaber, MD, of the Cardiovascular Division of Brigham and Women’s Hospital in Boston highlights the risks of venous thromboembolism (VTE) in coronary artery bypass surgery (CABG) patients. The diagnosis is often difficult as symptoms such as shortness of breath, change in oxygenation and leg swelling are attributed to post-surgical changes and therefore the diagnosis of pulmonary embolism (PE) or deep vein thrombosis (DVT) is not evaluated. Dr. Goldhaber highlighted statistics from his previous study indicating that when routine ultrasounds are performed following CABG, 20% test positive for DVT, with 50% occurring in the leg contralateral to the saphenous vein graft harvest. Most (84%) are distal DVTs while 16% are proximal. Only 1% of patients in his study displayed symptoms of VTE but one patient out of 330 studied died of PE. Another retrospective study cited by Dr. Goldhaber indicated the same percentage, 1%, of symptomatic VTE following CABG and this study noted that in two-thirds of those diagnosed with VTE, the diagnosis was made as an outpatient following hospital discharge. Goldhaber estimates that the mortality rate is 1% in asymptomatic patients and 2% to 4% in patients with symptoms of VTE. He recommends the following measures be taken to prevent VTE in post-CABG patients and that clinicians use a low threshold of suspicion for evaluating clinical symptoms of VTE:

1. Graduated compression stockings immediately post-op applied to the leg contralateral to the saphenous vein graft harvest
2. Intermittent pneumatic compression device stockings immediately post-op applied to the leg contralateral to the saphenous vein graft harvest
3. Fixed, low-dose subcutaneous unfractionated heparin 5000 U three times daily or enoxaparin 40 mg subcutaneous once daily or dalteparin 5000 IU subcutaneous once daily.

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