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Thromboresistant surfaces with low-dose anticoagulation alleviate clopidogrel-related complications in patients
Bader E Hussaini1, Hemant S Thatte, Barbara A Rhodes
1Department of Cardiothoracic Surgery, VA Boston Healthcare System, Boston, Mass, USA.
Insights
Patients taking clopidogrel before coronary artery bypass grafting (CABG) experienced shorter hospital stays. A specialized perfusion strategy using low-dose heparin and thromboresistant surfaces mitigated bleeding risks associated with clopidogrel.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Medical Devices
Background:
- Clopidogrel use within 7 days of coronary artery bypass grafting (CABG) conventionally increases bleeding risk.
- Conventional perfusion methods during CABG pose risks for patients on clopidogrel.
Purpose of the Study:
- To evaluate the impact of clopidogrel on patients undergoing CABG with a novel perfusion strategy.
- To assess the efficacy of thromboresistant surfaces and low-dose heparin in mitigating clopidogrel-related bleeding complications during CABG.
Main Methods:
- Retrospective study of isolated CABG patients (2005-2009).
- Comparison of 52 patients who received clopidogrel within 5 days pre-operation versus 182 who did not.
- Multivariate regression analysis to determine clopidogrel's effect on bleeding, transfusion, and outcomes.
Main Results:
- Increased 24-hour chest tube drainage observed in the clopidogrel group (P = .0007).
- No significant difference in intraoperative blood product transfusion; however, increased postoperative fresh frozen plasma use in the clopidogrel group (P = .0232).
- Risk-adjusted analysis indicated clopidogrel was not a predictor of transfusion, and patients on clopidogrel had shorter ICU and hospital stays.
Conclusions:
- Hemostatic complications from pre-CABG clopidogrel can be managed with a biocompatible perfusion strategy.
- Low-dose heparin and closed thromboresistant circuits effectively alleviate bleeding risks in patients on clopidogrel undergoing CABG.
Objective:
Numerous studies have shown that, when using conventional perfusion methodology, patients undergoing coronary artery bypass grafting within 7 days of receiving clopidogrel are at increased risk of bleeding, re-exploration, and blood transfusion. The purpose of this study was to evaluate the effect of clopidogrel administration before coronary artery bypass grafting on patients using thromboresistant surfaces with low-dose heparin during surgical intervention.
Methods:
Patients who underwent isolated coronary artery bypass grafting between 2005 and 2009 were incorporated in this retrospective study. Of these, 52 (22.2%) received clopidogrel within 5 days before the operation, and 182 (77.8%) did not. Regression models determined the effect of clopidogrel on the rate of chest re-exploration because of bleeding, 24-hour chest tube output, perioperative blood product transfusion, length of stay, morbidity, and perioperative mortality. Hemorrhage-related preoperative risk factors, as well as those found to be significant in univariate models, were included in the multivariate model.
Results:
Chest tube drainage was significantly increased during the first 24 hours after the operation in the clopidogrel group (679.7 ± 305.8 vs 516.6 ± 209.8 mL, P = .0007). The need for intraoperative blood product transfusion was similar; nevertheless, more patients receiving clopidogrel required fresh frozen plasma postoperatively (7.7% vs 1.1%, P = .0232). However, risk-adjusted logistic regression showed that exposure to clopidogrel was not a predictor of intraoperative or postoperative blood product transfusion. Lengths of stay in the intensive care unit and hospital were shorter in patients receiving clopidogrel.
Conclusions:
Hemostatic complications related to clopidogrel exposure within 5 days before an isolated coronary artery bypass grafting operation can be alleviated by the application of a biocompatible perfusion strategy using low-dose heparin in conjunction with a closed thromboresistant circuit.
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