Effect of clopidogrel on bleeding and transfusions after off-pump coronary artery bypass graft surgery: impact of discontinuation prior to surgery

Simon Maltais, Louis P. Perrault, Quoc Bao Do

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Objective: The use of antiplatelet drugs to treat acute myocardial infarction, unstable angina, acute coronary syndrome and secondary prevention following percutaneous coronary interventions is well accepted. However, it constitutes a serious risk of bleeding for patients undergoing coronary artery bypass grafting surgery (CABG). We evaluated the effect of aspirin and clopidogrel (CPDG), both irreversible platelet aggregation inhibitors, on operative bleeding and determined the optimal timing for their discontinuation before surgery. Method: Between July 2001 and December 2004, we reviewed our experience with 453 patients undergoing off-pump CABG surgery (OPCAB) who received CPDG (n = 101) or not (n = 352) preoperatively, and compared the intraoperative and postoperative bleeding to determine risks factors associated with blood or platelet transfusions. Results: Clopidogrel in OPCAB surgery is associated with higher intraoperative (702.24 ml vs 554.13 ml, p = 0.03) and postoperative bleeding (864.93 ml vs 603.75 ml, p = 0.03). The mean operative blood loss is higher in patients still on CPDG at the time of surgery compared to patients off CPDG at least 72 h before surgery (802 ml vs 554.13 ml, p < 0.0001). Blood loss in the later subgroup of patients is comparable to the control group without CPDG (p = NS). Clopidogrel is associated with more platelet transfusions (OR = 11.79, [1.48; 93.86]). Conclusion: Blood loss is higher in OPCAB patients receiving clopidogrel before surgery. However, discontinuation of clopidogrel three days (72 h) prior to the operation demonstrated a similar blood loss pattern compared to a control group. Clopidogrel is associated with more platelets, but not red blood cell transfusions following OPCAB surgery.

Original languageEnglish (US)
Pages (from-to)127-131
Number of pages5
JournalEuropean Journal of Cardio-thoracic Surgery
Volume34
Issue number1
DOIs
StatePublished - Jul 1 2008
Externally publishedYes

Fingerprint

clopidogrel
Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Hemorrhage
Transplants
Platelet Transfusion
Platelet Aggregation Inhibitors
Erythrocyte Transfusion
Control Groups

Keywords

  • Cardiac pharmacology
  • Cardiac physiology
  • Coronary disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

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title = "Effect of clopidogrel on bleeding and transfusions after off-pump coronary artery bypass graft surgery: impact of discontinuation prior to surgery",
abstract = "Objective: The use of antiplatelet drugs to treat acute myocardial infarction, unstable angina, acute coronary syndrome and secondary prevention following percutaneous coronary interventions is well accepted. However, it constitutes a serious risk of bleeding for patients undergoing coronary artery bypass grafting surgery (CABG). We evaluated the effect of aspirin and clopidogrel (CPDG), both irreversible platelet aggregation inhibitors, on operative bleeding and determined the optimal timing for their discontinuation before surgery. Method: Between July 2001 and December 2004, we reviewed our experience with 453 patients undergoing off-pump CABG surgery (OPCAB) who received CPDG (n = 101) or not (n = 352) preoperatively, and compared the intraoperative and postoperative bleeding to determine risks factors associated with blood or platelet transfusions. Results: Clopidogrel in OPCAB surgery is associated with higher intraoperative (702.24 ml vs 554.13 ml, p = 0.03) and postoperative bleeding (864.93 ml vs 603.75 ml, p = 0.03). The mean operative blood loss is higher in patients still on CPDG at the time of surgery compared to patients off CPDG at least 72 h before surgery (802 ml vs 554.13 ml, p < 0.0001). Blood loss in the later subgroup of patients is comparable to the control group without CPDG (p = NS). Clopidogrel is associated with more platelet transfusions (OR = 11.79, [1.48; 93.86]). Conclusion: Blood loss is higher in OPCAB patients receiving clopidogrel before surgery. However, discontinuation of clopidogrel three days (72 h) prior to the operation demonstrated a similar blood loss pattern compared to a control group. Clopidogrel is associated with more platelets, but not red blood cell transfusions following OPCAB surgery.",
keywords = "Cardiac pharmacology, Cardiac physiology, Coronary disease",
author = "Simon Maltais and Perrault, {Louis P.} and Do, {Quoc Bao}",
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TY - JOUR

T1 - Effect of clopidogrel on bleeding and transfusions after off-pump coronary artery bypass graft surgery

T2 - impact of discontinuation prior to surgery

AU - Maltais, Simon

AU - Perrault, Louis P.

AU - Do, Quoc Bao

PY - 2008/7/1

Y1 - 2008/7/1

N2 - Objective: The use of antiplatelet drugs to treat acute myocardial infarction, unstable angina, acute coronary syndrome and secondary prevention following percutaneous coronary interventions is well accepted. However, it constitutes a serious risk of bleeding for patients undergoing coronary artery bypass grafting surgery (CABG). We evaluated the effect of aspirin and clopidogrel (CPDG), both irreversible platelet aggregation inhibitors, on operative bleeding and determined the optimal timing for their discontinuation before surgery. Method: Between July 2001 and December 2004, we reviewed our experience with 453 patients undergoing off-pump CABG surgery (OPCAB) who received CPDG (n = 101) or not (n = 352) preoperatively, and compared the intraoperative and postoperative bleeding to determine risks factors associated with blood or platelet transfusions. Results: Clopidogrel in OPCAB surgery is associated with higher intraoperative (702.24 ml vs 554.13 ml, p = 0.03) and postoperative bleeding (864.93 ml vs 603.75 ml, p = 0.03). The mean operative blood loss is higher in patients still on CPDG at the time of surgery compared to patients off CPDG at least 72 h before surgery (802 ml vs 554.13 ml, p < 0.0001). Blood loss in the later subgroup of patients is comparable to the control group without CPDG (p = NS). Clopidogrel is associated with more platelet transfusions (OR = 11.79, [1.48; 93.86]). Conclusion: Blood loss is higher in OPCAB patients receiving clopidogrel before surgery. However, discontinuation of clopidogrel three days (72 h) prior to the operation demonstrated a similar blood loss pattern compared to a control group. Clopidogrel is associated with more platelets, but not red blood cell transfusions following OPCAB surgery.

AB - Objective: The use of antiplatelet drugs to treat acute myocardial infarction, unstable angina, acute coronary syndrome and secondary prevention following percutaneous coronary interventions is well accepted. However, it constitutes a serious risk of bleeding for patients undergoing coronary artery bypass grafting surgery (CABG). We evaluated the effect of aspirin and clopidogrel (CPDG), both irreversible platelet aggregation inhibitors, on operative bleeding and determined the optimal timing for their discontinuation before surgery. Method: Between July 2001 and December 2004, we reviewed our experience with 453 patients undergoing off-pump CABG surgery (OPCAB) who received CPDG (n = 101) or not (n = 352) preoperatively, and compared the intraoperative and postoperative bleeding to determine risks factors associated with blood or platelet transfusions. Results: Clopidogrel in OPCAB surgery is associated with higher intraoperative (702.24 ml vs 554.13 ml, p = 0.03) and postoperative bleeding (864.93 ml vs 603.75 ml, p = 0.03). The mean operative blood loss is higher in patients still on CPDG at the time of surgery compared to patients off CPDG at least 72 h before surgery (802 ml vs 554.13 ml, p < 0.0001). Blood loss in the later subgroup of patients is comparable to the control group without CPDG (p = NS). Clopidogrel is associated with more platelet transfusions (OR = 11.79, [1.48; 93.86]). Conclusion: Blood loss is higher in OPCAB patients receiving clopidogrel before surgery. However, discontinuation of clopidogrel three days (72 h) prior to the operation demonstrated a similar blood loss pattern compared to a control group. Clopidogrel is associated with more platelets, but not red blood cell transfusions following OPCAB surgery.

KW - Cardiac pharmacology

KW - Cardiac physiology

KW - Coronary disease

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