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Published on: September 15, 2023
Bleeding outcomes in patients given clopidogrel within 5 days of robotic coronary artery bypass graft procedure
Sophia Vainrub1, Asad E Patanwala, Richard Cosgrove
1University of Arizona, Tucson, AZ, USA.
Insights
Patients taking clopidogrel within five days of robotic-assisted coronary artery bypass grafting (rCABG) experienced significantly more postoperative bleeding. This finding suggests a need to re-evaluate current guidelines for this less invasive procedure.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Minimally Invasive Procedures
Background:
- Current guidelines recommend withholding clopidogrel 5 days before coronary artery bypass graft (CABG).
- The applicability of this recommendation to robotic-assisted CABG (rCABG), a less invasive procedure, remains unclear.
- rCABG's reduced invasiveness may alter bleeding risk compared to traditional CABG.
Purpose of the Study:
- To compare postoperative bleeding in rCABG patients who received clopidogrel within 5 days of surgery versus those who did not.
- To assess the impact of perioperative clopidogrel use on bleeding outcomes in rCABG.
Main Methods:
- Retrospective cohort study of 136 consecutive patients undergoing rCABG between January 1, 2012, and December 31, 2012.
- Patients were divided into two groups: those who received clopidogrel within 5 days of surgery and those who did not.
- Primary outcome was Bleeding Academic Research Consortium (BARC) definition for CABG-related bleeding; secondary outcome was 24-hour chest tube output.
Main Results:
- Twenty-six percent of patients who received clopidogrel experienced BARC-defined bleeding, compared to 8% of those who did not (P = .011).
- Median 24-hour chest tube output was significantly higher in the clopidogrel group (900 mL vs. 735 mL, P = .002).
- 39% of patients received clopidogrel within 5 days of rCABG.
Conclusions:
- Perioperative clopidogrel use within 5 days of rCABG is associated with increased postoperative bleeding.
- The findings suggest that current guidelines for clopidogrel discontinuation may need adjustment for rCABG procedures.
- Increased chest tube output further supports the association between clopidogrel and heightened bleeding risk in rCABG.
Background:
Current guidelines recommend that clopidogrel should be held for 5 days prior to coronary artery bypass graft (CABG) procedure. However, it is unknown if this recommendation should apply to robotic-assisted (rCABG), which is less invasive because it does not involve sternotomy and thus reduces the risk of bleeding.
Objective:
To compare postoperative bleeding for rCABG patients who were taking clopidogrel within 5 days of the procedure with those who were not taking clopidogrel.
Methods:
This was a retrospective cohort study conducted between January 1, 2012 and December 31, 2012 of consecutive patients undergoing rCABG. Patients were categorized into 2 groups based on whether or not clopidogrel was administered within 5 days prior to the date of surgery. The primary outcome measure was the occurrence of the Bleeding Academic Research Consortium (BARC) definition for CABG-related bleeding. The secondary outcome measure was a comparison of chest tube output during the first 24-hour postoperative period.
Results:
A total of 136 rCABG patients were included in the final analyses. Of these, 39 (29%) received clopidogrel within 5 days of surgery. CABG-related bleeding using the BARC definition occurred in 26% of patients who received clopidogrel and 8% of patients who did not (P = .011). Median chest tube output during the first 24-hour postoperative period was also greater in patients who received clopidogrel (900 vs 735 mL, P = .002).
Conclusions:
The use of clopidogrel within 5 days of rCABG is associated with greater postoperative bleeding and chest tube output, as defined by the BARC criteria.
