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Impact of clopidogrel use on mortality and major bleeding in patients undergoing coronary artery bypass surgery
Nahum Nesher1, Steve K Singh, Hosam F Fawzy
1Division of Cardiac and Vascular Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. nesher61@gmail.com
Insights
Clopidogrel use before urgent coronary artery bypass grafting (CABG) did not increase in-hospital death or major bleeding. Stopping clopidogrel preoperatively is not a significant factor for adverse outcomes in these patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Clopidogrel use before coronary artery bypass grafting (CABG) presents a dilemma, balancing bleeding risk against ischemic events.
- Urgent CABG necessitates careful consideration of preoperative antiplatelet therapy.
- Understanding clopidogrel's impact on outcomes in urgent CABG is crucial for patient management.
Purpose of the Study:
- To evaluate the effect of clopidogrel on mortality and major bleeding in patients undergoing urgent CABG.
- To determine if preoperative clopidogrel use is an independent risk factor for adverse outcomes in urgent CABG.
- To assess the influence of the timing of clopidogrel cessation on surgical outcomes.
Main Methods:
- Retrospective review of 451 consecutive patients undergoing urgent isolated CABG.
- Comparison of outcomes between patients who received clopidogrel (n=189) and those who did not (n=262) within 5 days preoperatively.
- Analysis of in-hospital death, massive transfusion, and massive blood loss as primary endpoints.
- Multivariate regression analysis to identify independent predictors of adverse outcomes.
Main Results:
- No significant difference in in-hospital death (7% vs. 6%, P=0.9) or massive bleeding between clopidogrel and no-clopidogrel groups.
- Adjusting for the timing of clopidogrel cessation did not alter the observed outcomes.
- Multivariate analysis indicated that clopidogrel use or its preoperative discontinuation interval did not predict adverse events.
- Preoperative renal dysfunction, lower hemoglobin, and peripheral vascular disease were significant independent predictors of poor outcomes.
Conclusions:
- Preoperative clopidogrel use is not associated with increased in-hospital mortality or major bleeding in patients undergoing urgent CABG.
- The duration of clopidogrel cessation prior to urgent CABG does not appear to be a significant risk factor for adverse early outcomes.
- Clinical decisions regarding urgent CABG in patients on clopidogrel should consider factors like renal function and hemoglobin levels rather than solely the antiplatelet agent.
Abstract:
Patients who received clopidogrel prior to coronary bypass surgery are at increased risk for bleeding that must be balanced with risk of ongoing ischemia if coronary artery bypass grafting is delayed. This study aimed to evaluate the impact of clopidogrel on mortality and major bleeding in patients undergoing urgent coronary bypass surgery. We reviewed 451 consecutive patients who underwent urgent isolated coronary bypass surgery; 262 had not received clopidogrel, whereas 189 received clopidogrel < or = 5 days preoperative. The primary endpoint was in-hospital death, massive transfusion or massive blood loss. Patient characteristics were almost similar between groups. There was no difference in in-hospital death or massive bleeding indices between groups (clopidogrel: 7% vs. no clopidogrel: 6%, P = 0.9). No difference was observed even after adjusting for the date of stopping clopidogrel preoperatively. Multivariate regression analysis showed that clopidogrel or the duration it was stopped preoperatively, did not predict adverse outcomes. Significant independent predictors included preoperative renal dysfunction, hemoglobin level and peripheral vascular disease. clopidogrel, or the time it was stopped prior to surgery, was not a risk factor for in-hospital death, massive bleeding, or other poor early outcomes in patients undergoing urgent coronary artery bypass surgery.
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