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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
10:28

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

Urgent or emergent coronary revascularization using bilateral internal thoracic artery after previous clopidogrel

B Gansera1, F Schmidtler, K Spiliopoulos

  • 1Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Germany. herzchirurgie@kh-bogenhausen.de

The Thoracic and Cardiovascular Surgeon
|September 23, 2003
PubMed

Insights

Clopidogrel use before urgent coronary artery bypass grafting (CABG) increases bleeding complications, including higher chest tube output and re-exploration rates. However, using bilateral internal thoracic arteries (ITAs) is feasible despite clopidogrel exposure.

Area of Science:

  • Cardiovascular Surgery
  • Pharmacology
  • Anesthesiology

Background:

  • Clopidogrel is standard for stent thrombosis prevention but increases bleeding risks during urgent coronary artery bypass grafting (CABG).
  • Evaluating clopidogrel's impact on bleeding complications in urgent CABG is crucial for patient safety.

Purpose of the Study:

  • To assess the effect of pre-operative clopidogrel on bleeding complications in patients undergoing urgent CABG.
  • To determine if using bilateral internal thoracic arteries (ITAs) is safe in patients with clopidogrel exposure.

Main Methods:

  • Retrospective analysis of 128 patients undergoing urgent/emergent CABG using both ITAs.
  • Comparison of 64 patients with recent clopidogrel/aspirin use versus 64 patients without clopidogrel.
  • Evaluation of chest tube output, re-exploration, blood product use, ventilation time, and ICU stay.

Main Results:

  • The clopidogrel group showed significantly higher chest tube output (977 vs. 788 ml) and re-exploration rates (7.81% vs. 0%).
  • Increased need for blood products, particularly platelets, was observed in the clopidogrel group.
  • No significant differences in mechanical ventilation time or ICU stay were noted between groups.

Conclusions:

  • Pre-operative clopidogrel significantly increases bleeding complications and re-exploration rates in urgent CABG.
  • Routine use of bilateral ITAs is feasible in patients exposed to clopidogrel, with manageable bleeding risks.
Abstract

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