Related Experiment Video
Updated: Jun 19, 2026
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Potential unrecognised costs of clopidogrel pretreatment in acute coronary syndrome
Jay P Bae1, Paul P Dobesh, Patrick L McCollam
1Eli Lilly and Company, Indianapolis, IN, USA.
Insights
Clinical practice shows poor adherence to the 5-day waiting period after clopidogrel before coronary artery bypass graft (CABG) surgery. This guideline adherence impacts patient care and incurs significant hospital costs, with each extra day costing approximately £1,400.
Area of Science:
- Cardiology
- Health Economics
- Clinical Practice Guidelines
Background:
- Current guidelines recommend a 5-day waiting period after clopidogrel administration before coronary artery bypass graft (CABG) surgery.
- Adherence to this guideline is crucial for balancing bleeding risk and timely revascularization.
Purpose of the Study:
- To evaluate adherence to the 5-day waiting period guideline for CABG surgery post-clopidogrel.
- To assess the associated healthcare costs of adhering to or deviating from this waiting period.
Main Methods:
- Retrospective analysis of a nationwide inpatient database (Solucient ACTracker).
- Inclusion of patients admitted for acute coronary syndrome (ACS) who underwent same-stay CABG.
- Regression analysis to estimate the cost of additional hospital days.
Main Results:
- Only 16.9% of patients adhered to the recommended 5-day waiting period.
- 14.6% of patients with ACS underwent CABG surgery on the same day as admission (day 0).
- Higher adherence was observed in teaching/rural hospitals, and among female, elderly, and urgently admitted patients.
Conclusions:
- Adherence to the 5-day waiting period after clopidogrel before CABG is suboptimal in clinical practice.
- Reasons for low adherence may involve a trade-off between urgent clinical need and bleeding risk, alongside economic considerations.
- Each additional hospital day post-CABG costs approximately £1,400, indicating a substantial economic impact of a full 5-day wait.
Objective:
To examine adherence in clinical practice to the American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations of observing a 5-day waiting period after clopidogrel administration before undergoing coronary artery bypass graft (CABG) surgery and to examine the costs of waiting.
Methods:
This retrospective study used a nationwide inpatient database (Solucient ACTracker) to identify patients who were admitted for acute coronary syndrome (ACS), and who had same-stay CABG. Cost of additional days of stay was estimated using regression analysis.
Results:
The recommended 5-day waiting was adhered to in 16.9% (n=3,809) of patients. The percentage of patients with ACS undergoing CABG surgery on day 0 was 14.6%. Adherence to the waiting was higher for teaching and rural hospitals; and in female and elderly patients and urgent admissions.
Conclusions:
The recommended 5-day waiting for CABG surgery after clopidogrel treatment is poorly adhered to in clinical practice. This study was unable to determine specific reasons for the low adherence; however, there may be a compromise between the clinically urgent need for revascularisation and increased risk of bleeding, as well as economic costs associated with waiting. The cost of an additional hospital day in this group of patients was approximately £1,400 per day or £7,000 for 5 days. Thus, a full 5-day wait would have a significant economic impact on hospital costs.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care