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Hypercoagulability and platelet inhibition after OPCAB. Randomized intervention with clopidogrel

Allan Bybeck Nielsen1, Louise Bochsen, Daniel A Steinbrüchel

  • 1Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark. allan@bybeck.dk

Scandinavian Cardiovascular Journal : SCJ
|September 14, 2007
PubMed

Insights

Off-Pump Coronary Artery Bypass (OPCAB) surgery may cause temporary hypercoagulability. Clopidogrel showed increased platelet inhibition post-OPCAB, but further research is needed to confirm its clinical benefit.

Area of Science:

  • Cardiovascular Surgery
  • Thrombosis and Hemostasis

Background:

  • Off-Pump Coronary Artery Bypass (OPCAB) surgery is associated with concerns regarding hypercoagulability.
  • Standard acetylsalicylic acid prophylaxis may be insufficient in the early weeks following OPCAB.

Purpose of the Study:

  • To investigate the effectiveness of clopidogrel in managing hypercoagulability after OPCAB surgery.
  • To assess platelet inhibition and hypercoagulability markers in patients undergoing OPCAB.

Main Methods:

  • A randomized trial involving 29 patients assigned to clopidogrel (75 mg) or a control group for 30 days post-OPCAB.
  • Thrombelastography (TEG) and platelet inhibition assays were used to evaluate coagulation status over a 2-month follow-up period.

Main Results:

  • A significant increase in TEG maximum amplitude (hypercoagulability) was observed 5 days post-surgery in both groups.
  • Platelet inhibition was significantly higher in the clopidogrel group (34.1%) compared to the control group (11.0%) at 1 month.

Conclusions:

  • Hypercoagulability post-OPCAB is transient, resolving by 1 month.
  • No immediate clinical adverse effects of this transient hypercoagulability were observed.
  • Further studies are required to determine the optimal antithrombotic strategy, including the role of clopidogrel, after OPCAB.
Abstract

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