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Clopidogrel treatment before coronary artery bypass graft surgery increases postoperative morbidity and blood product
Farzan Filsoufi1, Parwis B Rahmanian, Javier G Castillo
1Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. Farzan.filsoufi@mountsinai.org
Insights
Preoperative clopidogrel use in patients undergoing coronary artery bypass graft surgery significantly increases the need for blood transfusions and may raise mortality and morbidity risks. Delaying surgery when possible is recommended for these patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- An increasing number of patients undergoing coronary artery bypass graft (CABG) surgery are on clopidogrel, a P2Y12 adenosine-5'-diphosphate (ADP) receptor inhibitor.
- Clopidogrel inhibits platelet aggregation, raising concerns about its impact on surgical outcomes.
Purpose of the Study:
- To evaluate the effect of preoperative clopidogrel treatment on postoperative bleeding, mortality, and morbidity in patients undergoing isolated CABG surgery.
Main Methods:
- Retrospective cohort study at a single university hospital.
- Compared 72 patients who received preoperative clopidogrel with 72 matched control patients undergoing isolated CABG.
- Data collected included transfusion requirements, mortality, morbidity, and length of hospital stay.
Main Results:
- Clopidogrel-treated patients required significantly more platelet and red blood cell transfusions (p < 0.001).
- All-cause mortality and morbidity were significantly higher in the clopidogrel group (p = 0.031).
- Intensive care unit and hospital stays were significantly longer for clopidogrel-treated patients (p = 0.002 and p = 0.003, respectively).
Conclusions:
- Preoperative clopidogrel is associated with increased transfusion needs, higher mortality, and major morbidity after CABG surgery.
- Delaying CABG in patients on clopidogrel, unless medically indicated, is advisable.
- Findings align with recommendations from recent American Heart Association guidelines.
Objectives:
An increasing number of patients are referred for coronary artery bypass graft surgery while treated with clopidogrel. This agent inhibits the platelet P2Y12 adenosine-5'-diphosphate (ADP) receptor, which results in an inhibition of platelet aggregation. The aim of this study was to determine the effect of preoperative clopidogrel treatment on postoperative bleeding, mortality, and morbidity in patients after coronary artery bypass graft surgery.
Design:
Retrospective cohort study.
Setting:
University hospital (single institution).
Participants:
One hundred forty-four patients who underwent isolated coronary artery bypass graft surgery.
Interventions:
Seventy-two patients who received clopidogrel during the preoperative period formed the study group. Seventy-two patients (matched based on age, sex, and preoperative risk profile) served as the control group.
Measurements And Main Results:
Clopidogrel-treated patients received significantly more platelet (4.4 +/- 5.7 v 1.3 +/- 3.2 U, p < 0.001) and red blood cell (5.1 +/- 4.2 v 2.6 +/- 2.6 U, p < 0.001) transfusions compared with the control group. All-cause mortality and morbidity were significantly higher in clopidogrel-treated patients (n = 7, 9% v n = 1, 1%; p = 0.031). In addition, the lengths of stay in the intensive care unit and the hospital were significantly longer in these patients (2.5 +/- 2.7 v 1.4 +/- 0.9 days, p = 0.002; 9.9 +/- 11 v 6 +/- 2.5 days, p = 0.003). Despite an increased morbidity in the clopidogrel group, the midterm survival was similar between the 2 groups (1-year and 5-year survival 97% +/- 2% and 95.7% +/- 3% v 100% +/- 0% and 87% +/- 10%, respectively; p = 0.885).
Conclusions:
Preoperative clopidogrel is associated with increased transfusion requirement after coronary artery bypass graft surgery. The present data suggest that all-cause mortality and major morbidity may also increase in these patients. In clopidogrel-treated patients, coronary artery bypass graft surgery should be delayed in the absence of specific medical indications as recommended by recent American Heart Association guidelines.
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