Impact of preoperative clopidogrel in off pump coronary artery bypass surgery: a propensity score analysis

Area of Science:

• Cardiology
• Cardiac Surgery
• Pharmacology

Background:

• Off-pump coronary artery bypass grafting (OPCAB) is a common cardiac surgery.
• Clopidogrel is an antiplatelet medication frequently used in patients with coronary artery disease.
• The safety of OPCAB in patients recently treated with clopidogrel requires careful evaluation due to bleeding concerns.

Purpose of the Study:

• To assess the impact of recent clopidogrel use (within 7 days) on postoperative bleeding complications after OPCAB.
• To identify specific bleeding-related risks associated with pre-operative clopidogrel administration in OPCAB patients.

Main Methods:

• A cohort of 1104 patients undergoing OPCAB between January 2003 and December 2006 was analyzed.
• Patients were stratified into two groups: recent clopidogrel users (within 7 days) and non-users.
• Propensity score matching was employed to control for baseline differences between the groups.

Main Results:

• The clopidogrel group exhibited a higher incidence of unstable patients requiring emergency surgery and higher EuroSCORE.
• Post-propensity score analysis revealed significantly increased requirements for fresh frozen plasma (18.1% vs 8.5%) and reoperations for bleeding (5.6% vs 0.5%) in the clopidogrel group.
• The clopidogrel group also showed a higher need for postoperative mechanical ventilation (4% vs 10%).

Conclusions:

• Recent clopidogrel use prior to OPCAB is significantly associated with an elevated risk of postoperative bleeding.
• Despite increased bleeding complications, mortality rates and length of hospital stay were comparable between the groups.
• These findings underscore the importance of considering recent clopidogrel use when assessing bleeding risk in OPCAB patients.