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The impact of clopidogrel therapy on postoperative bleeding after robotic-assisted coronary artery bypass surgery
William T Daniel1, Henry A Liberman2, Patrick Kilgo1
1Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Insights
Patients on clopidogrel undergoing robotic-assisted coronary artery bypass graft surgery (CABG) experienced increased bleeding and transfusion rates. Delaying surgery after clopidogrel administration is recommended to mitigate these risks.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure for treating coronary artery disease.
- Robotic-assisted surgery offers potential benefits such as minimally invasive approaches.
- Clopidogrel is an antiplatelet medication frequently used in patients with coronary artery disease.
Purpose of the Study:
- To evaluate the risk of bleeding complications in patients undergoing robotic-assisted CABG while on clopidogrel therapy.
- To compare bleeding outcomes between patients on clopidogrel and those not on the medication before robotic-assisted CABG.
Main Methods:
- A retrospective study of 322 patients undergoing robotic-assisted CABG between 2008 and 2011.
- Patients were categorized into two groups: those receiving clopidogrel within 5 days of surgery (n=64) and those not (n=258).
- Propensity analysis using 31 preoperative variables was employed to control for confounding factors.
Main Results:
- The clopidogrel group showed significantly higher 24-hour chest tube drainage (1003 ± 572 ml vs. 782 ± 530 ml, P=0.004).
- A greater proportion of patients in the clopidogrel group required blood transfusions (35.9% vs. 20.9%, P=0.01).
- Logistic regression confirmed increased chest tube drainage (P=0.02) and transfusion rates (OR=2.30, P=0.01) in the clopidogrel group.
Conclusions:
- Robotic-assisted CABG patients on clopidogrel face a higher risk of postoperative bleeding and blood transfusions.
- Despite the minimally invasive nature of robotic surgery, delaying the procedure after clopidogrel administration is advisable.
- Careful consideration of clopidogrel timing is crucial for optimizing outcomes in robotic-assisted CABG.
Objectives:
The purpose of this study was to determine whether patients undergoing robotic-assisted coronary artery bypass graft surgery (CABG) on clopidogrel had an increased risk of bleeding complications compared with those not on clopidogrel.
Methods:
From 2008 to 2011, 322 patients underwent robotic-assisted CABG either as an isolated procedure or as part of a hybrid coronary revascularization procedure (HCR). Patients were classified according to whether they received clopidogrel within 5 days of surgery or intraoperatively (n = 64) compared with those who never received or who had discontinued clopidogrel therapy >5 days before surgery (n = 258). A propensity analysis using 31 preoperative variables was used to control for confounding variables. In a subgroup analysis, patients undergoing one-stage HCR (clopidogrel load 600 mg in odds ratio (OR) prior to stenting) were compared with patients in the clopidogrel group who underwent two-stage HCR.
Results:
In the Clopidogrel group, the mean interval between surgery and last dose of clopidogrel was 2.1 ± 1.5 days. Compared with the No Clopidogrel group, the Clopidogrel group had greater 24-h chest tube drainage (1003 ± 572 vs 782 ± 530 ml, P = 0.004) and more blood transfusions (35.9%, 23 of 64 patients vs 20.9%, 54 of 258 patients, P = 0.01). On logistic regression analysis, there was greater 24-h chest tube drainage in the Clopidogrel group (+198 ml, P = 0.02) and a significantly higher incidence of blood transfusion (OR = 2.30, P = 0.01). In the subgroup analysis, patients undergoing one-stage HCR (n = 17) had greater 24-h chest tube drainage compared with patients undergoing two-stage HCR (1262 vs 909 ml, P = 0.03).
Conclusions:
Patients undergoing robotic-assisted CABG on clopidogrel had more postoperative bleeding and a higher incidence of blood transfusion. Therefore, despite a less invasive approach, surgery should be delayed in these patients when possible.
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