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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
Summary
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.
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