Related Experiment Video
Updated: May 28, 2026
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Risk factors for re-exploration due to bleeding after coronary artery bypass grafting
Ulrica Alström1, Fredrik Granath, Orjan Friberg
1Department of Cardiothoracic Surgery and Anesthesiology, Uppsala University Hospital, Sweden. u.a@surgsci.uu.se
Insights
Clopidogrel significantly increases bleeding re-exploration risk after coronary artery bypass graft (CABG) surgery. Aprotinin showed a protective effect, while other clinical factors had limited predictive value.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Clinical Risk Assessment
Background:
- Re-exploration due to bleeding is a significant complication following coronary artery bypass graft (CABG) surgery.
- Identifying predictive clinical risk factors and the impact of perioperative medications is crucial for patient outcomes.
Purpose of the Study:
- To identify clinical risk factors associated with re-exploration for bleeding after primary CABG.
- To evaluate the influence of antiplatelet and antifibrinolytic drugs on the risk of re-exploration.
Main Methods:
- Retrospective analysis of 3000 CABG patients using logistic regression to identify clinical risk factors.
- Case-control study (n=228) to assess antithrombotic and hemostatic therapy exposure.
- Calculation of re-exploration proportion attributed to specific drugs based on odds ratios.
Main Results:
- Clinical risk factors showed limited ability to predict re-exploration (C-index = 0.64).
- Clopidogrel was identified as a significant risk factor for re-exploration (OR 4.7).
- Aprotinin demonstrated a protective effect against re-exploration (OR 0.2).
Conclusions:
- Clopidogrel is a key risk factor for post-CABG bleeding re-exploration, accounting for at least 25% of cases.
- Beyond specific medications like clopidogrel and aprotinin, strong clinical risk factors for re-exploration are not evident.
Objective:
The study aimed to investigate relevant clinical risk factors for re-exploration due to bleeding after primary coronary artery bypass graft (CABG) surgery, and to evaluate the influence of antiplatelet and antifibrinolytic drugs.
Design:
Three retrospective analyses were performed on patients who underwent CABG: (1) Logistic regression was used to identify clinical risk factors for re-exploration (n = 3000). (2) A case-control study (n = 228) was used to obtain information on exposure of antithrombotic and hemostatic therapy. (3) Based on exposure to antiplatelet and antifibrinolytic therapy, and odds ratios (ORs) in multivariate logistic models, the proportion of re-explorations attributed to these drugs was calculated.
Results:
A receiver operating characteristic curve was created for clinical risk factors. The C-index was 0.64, indicating limited ability to predict re-exploration for bleeding. Clopidogrel was the only drug influencing the risk of re-exploration (OR 3.2, 95% CI 1.7-5.9). The harmful effect of clopidogrel was confirmed in multivariate model (OR 4.7, 95% CI 2.2-9.9), and aprotinin had a protective effect of the same magnitude (OR 0.2, 95% CI 0.1-0.6).
Conclusions:
Clopidogrel is an essential risk factor for re-exploration due to bleeding, and attributable to at least one-quarter of surveyed cases. Aside from pharmaceuticals, there are no strong clinical risk factors.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Aneurysm III: Interprofessional Care
01:21Cardiac Catheterization II: Right Heart Catheterization
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:27Coronary Artery Disease V: Interprofessional Care
01:22Aneurysm IV: Nursing Management