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Clopidogrel does not increase bleeding and allogenic blood transfusion in coronary artery surgery
Hasan Karabulut1, Fevzi Toraman, Serdar Evrenkaya
1Department of Cardiovascular Surgery, Acibadem Hospital, Tekin Sokak, No. 8, 34718 Acibadem, Istanbul, Turkey. hasankarabulut@turk.net
Insights
Preoperative clopidogrel use did not increase bleeding or transfusion needs in coronary artery bypass graft (CABG) patients. This study found no significant differences in outcomes for patients taking clopidogrel before surgery.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Postoperative bleeding is a significant complication following coronary artery surgery.
- Platelet dysfunction is a primary contributor to this bleeding.
- Clopidogrel is an antiplatelet medication that inhibits platelet aggregation.
Purpose of the Study:
- To evaluate the impact of preoperative clopidogrel use on bleeding and blood product transfusion requirements after coronary artery bypass grafting (CABG).
Main Methods:
- A prospective study of 1628 patients undergoing isolated CABG.
- Compared outcomes between patients taking clopidogrel preoperatively (48 patients) and those not taking it.
- Analyzed data on chest tube output, reexploration rates, blood product transfusion, and length of stay.
Main Results:
- No significant differences were observed in reexploration rates, blood product transfusion needs, chest tube output, or length of stay between clopidogrel recipients and non-recipients.
- Specific analysis showed no increased risk of bleeding or transfusion in either elective or non-elective CABG patients on clopidogrel.
Conclusions:
- Preoperative use of clopidogrel is not associated with increased postoperative bleeding or the need for surgical reexploration after CABG.
- The study suggests that clopidogrel does not elevate the risk of blood or blood product transfusion in patients undergoing CABG.
Objectives:
Platelet dysfunction is one of the major reasons of postoperative bleeding following coronary artery surgery. The aim of this study was to evaluate the effects of clopidogrel; a specific and potent irreversible inhibitor of platelet aggregation; on bleeding and use of blood and blood products after coronary artery bypass surgery (CABG).
Methods:
Preoperative patient characteristics and perioperative and postoperative data were collected prospectively in 1628 consecutive patients undergoing isolated CABG performed by the same surgical and anesthesia team. Of these, 48 were receiving clopidogrel preoperatively. Of the 1628 patients, 1456 underwent elective and 172 (10.6%) underwent non-elective operation. Thirty-six (2.5%) of the elective patients and 12 (7%) of the non-elective patients were using clopidogrel, preoperatively. Baseline characteristics, chest tube output, and the need for reexploration or for blood and blood product transfusion of clopidogrel recipients and non-recipients were compared. The clopidogrel group had higher prothrombin time level (12.6+/-1.6; 11.5+/-1.7 s, (P=0.013), however comparable aPTT level (32.6+/-4.5 vs. 31.4+/-4.5 s), and platelet count (275,000+/-98,000 vs. 280,000+/-72,000 dl(-1)).
Results:
The need for reexploration or for blood and blood product transfusion, chest tube output, ICU length of stay (20.1+/-2.9 vs. 21.9+/-13.5 h; P=NS), and hospital length of stay (5.5+/-1.7 vs. 5.4+/-2.1 days; P=NS) were similar in clopidogrel recipients and non-recipients, respectively. Further analysis demonstrated no significant difference in use of homologous blood or fresh frozen plasma, amount of postoperative bleeding and reoperation rates for bleeding as well as length of intensive care unit and hospital stay between the clopidogrel and the control groups both in elective and non-elective patients.
Conclusions:
The results of this study suggest that preoperative use of clopidogrel is not associated with increased bleeding and need for surgical exploration as well as risk of blood and blood product transfusion after CABG.
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