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Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery

Christine R Herman1, Karen J Buth, Blaine A Kent

  • 1Division of Cardiac Surgery, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.

The Annals of Thoracic Surgery
|January 28, 2010
PubMed

Insights

Recent clopidogrel use before cardiac surgery increases transfusion and bleeding risks. Surgeons should consider the time since the last dose to mitigate complications in acute coronary syndrome patients.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Pharmacology

Background:

  • Increasing use of clopidogrel for acute coronary syndrome.
  • Patients undergoing urgent cardiac surgery may have impaired platelet function due to clopidogrel.
  • Need to assess the impact of recent clopidogrel administration on surgical outcomes.

Purpose of the Study:

  • To determine if recent clopidogrel administration predicts transfusion and hemorrhagic complications in cardiac surgery patients.
  • To evaluate the association between clopidogrel cessation interval and adverse outcomes.
  • To identify risk factors for complications in patients on clopidogrel.

Main Methods:

  • Retrospective study of isolated coronary artery bypass graft (CABG), isolated valve, or combined CABG/valve surgery patients (2004-2008).
  • Outcomes assessed: transfusion and hemorrhagic complication.
  • Clopidogrel stop interval analyzed in daily increments (0-5 days, >5 days, none) using logistic regression.

Main Results:

  • 26.4% of 3,779 patients received clopidogrel preoperatively.
  • Overall transfusion rate: 34.1%; hemorrhagic complication rate: 4.1%.
  • Clopidogrel use within 24 hours independently predicted transfusion (OR 2.4) and hemorrhagic complication (OR 2.1).

Conclusions:

  • Patients receiving clopidogrel within 24 hours of cardiac surgery face higher risks of transfusion and bleeding.
  • The interval since the last clopidogrel dose is a critical factor in surgical planning.
  • Timing of surgery should be adjusted based on clopidogrel cessation to minimize patient risk.
Abstract

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