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Postoperative blood loss in patients undergoing coronary artery bypass surgery after preoperative treatment with
Cristina E Firanescu1, Elisabeth J Martens, Jacques P A M Schönberger
1Department of Cardio-thoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands. cristina.firanescu@cze.nl
Insights
Stopping clopidogrel (antiplatelet medication) on the day of coronary artery bypass grafting (CABG) surgery significantly increases blood loss and the need for blood products. Discontinuing 3 or 5 days prior showed similar, lower outcomes.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Transfusion Medicine
Background:
- Optimal timing for clopidogrel discontinuation before surgery is debated.
- Clopidogrel is an antiplatelet medication used to prevent blood clots.
Purpose of the Study:
- To determine the effect of preoperative clopidogrel administration timing on postoperative blood loss.
- To assess the impact on homologous blood product requirements after coronary artery bypass grafting (CABG).
- To evaluate perioperative complications associated with clopidogrel discontinuation timing.
Main Methods:
- 130 patients undergoing elective CABG were randomized into three groups.
- Group 1: Clopidogrel discontinued 5 days before surgery.
- Group 2: Clopidogrel discontinued 3 days before surgery.
- Group 3: Clopidogrel discontinued on the day of surgery.
Main Results:
- Group 3 (discontinued on day of surgery) showed significantly higher postoperative blood loss (929+/-472 ml) compared to Group 1 (664+/-312 ml).
- Patients in Group 3 required significantly more homologous blood products and fresh frozen plasma (FFP) transfusions.
- Continuing clopidogrel until surgery day predicted increased blood loss and blood product requirements.
Conclusions:
- Continuing clopidogrel until the day of CABG surgery significantly increases postoperative blood loss and transfusion needs.
- Discontinuing clopidogrel 3 days preoperatively resulted in similar blood loss and product use as discontinuing 5 days prior.
- A 3-day preoperative discontinuation appears safe regarding blood loss and transfusion requirements.
Objective:
The optimal timing for discontinuation of clopidogrel before surgery remains under debate. The purpose of this study is to determine the effect of preoperative clopidogrel administration on postoperative blood loss and the total requirements of homologous blood products after coronary artery bypass grafting (CABG). We also evaluated the perioperative complications.
Methods:
Consecutive patients (n=130) undergoing elective CABG were recruited and randomised between 2006 and 2007. In 38 patients (group 1), treatment with clopidogrel was discontinued 5 days prior to surgery, in 40 patients (group 2) 3 days before surgery and in 40 other patients (group 3) clopidogrel was stopped on the day of surgery.
Results:
Significantly more postoperative blood loss was observed in group 3 compared to group 1 (929+/-472 ml vs 664+/-312 ml; p=0.009). Other group comparisons were not significant. Blood loss after 12 h and at drain removal was also significantly higher in group 3. Patients in group 3 also had higher total requirements of homologous blood products (p=0.046) and a significantly higher need for fresh frozen plasma (FFP) transfusion (p=0.034). Univariable regression analyses revealed that continuing clopidogrel till the day of surgery (group 3) was predictive for postoperative blood loss (beta=0.289; p=0.007) and the total requirements of homologous blood products after surgery (beta=0.280; p=0.008). These effects remained the same in multivariable analyses.
Conclusions:
Continuation of clopidogrel until the day of surgery induces significantly more postoperative blood loss and increases significantly the total requirements of homologous blood products and FFP transfusion after surgery. The blood loss and the use of blood products in the group that stopped at 3 days preoperatively were similar to that of the group that stopped at 5 days preoperatively.
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