Postoperative Bleeding Following Preoperative Clopidogrel Administration in Patients with Haemoglobin Level Above 110
Sasa Milan Kacar1, Aleksandar Mikic1, Mirjana Božidar Kačar1
1Clinical Centers of Serbia - Clinic for Cardiac Surgery, Beograd, Serbia.
Insights
Dual antiplatelet therapy (DAPT) within five days of urgent coronary artery bypass grafting (CABG) did not increase postoperative bleeding in patients with adequate hemoglobin. This suggests CABG can be safely performed shortly after stopping DAPT.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Anesthesiology
Background:
- Patients with acute coronary syndrome often receive dual antiplatelet therapy (DAPT) before procedures.
- Approximately 10% of these patients require urgent or emergent coronary artery bypass grafting (CABG).
- DAPT can increase surgical bleeding risk, posing a challenge for urgent CABG.
Purpose of the Study:
- To investigate the impact of DAPT on postoperative bleeding in patients undergoing urgent/emergent CABG.
- To assess bleeding risk in patients with hemoglobin > 110 g/L who had DAPT within 5 days of CABG.
Main Methods:
- Prospective data collection from 122 CABG patients (March 2008 - August 2013).
- Stratification into two groups: DAPT within 5 days of CABG (n=65) vs. DAPT discontinued >5 days prior (n=57).
- Exclusion of patients requiring reoperation, combined procedures, or off-pump revascularization.
Main Results:
- No hospital mortality was observed in either group.
- Mean chest tube losses did not significantly differ between groups.
- Patients receiving DAPT within 5 days of CABG required more transfused red blood cells and platelets.
Conclusions:
- Urgent/emergent CABG in acute coronary syndrome patients with hemoglobin > 110 g/L is safe and effective.
- Performing CABG less than 5 days after DAPT discontinuation appears feasible and safe.
- Further consideration for early CABG post-DAPT may be warranted based on clinical indication.
Introduction:
Patients with acute coronary syndrome usually receive dual antiplatelet therapy (DAPT) (usually clopidogrel + aspirin) prior to coronary catheterization, and approximately 10% of these patients require coronary artery bypass grafting (CABG). DAPT has favorable effects on prevention of thrombus formation, but it can have deleterious effects on surgical hemostasis. Anaemia, if present, gives additional risk to such patients. The aim of this study was to examine if DAPT affects postoperative bleeding in patients with haemoglobin levels above 110 g/L, who underwent urgent or emergent CABG, less than five days after stopping DAPT therapy.
Methods:
Data were collected prospectively on 122 CABG patients, operated by a surgical team from March 2008 to August 2013. Patients were stratified into two groups: group 1 received DAPT within 5 days of CABG (n=65), and group 2 where DAPT was discontinued for more than 5 days prior to CABG (n=57). All patients were diagnosed with acute coronary syndrome preoperatively, and all of them had haemoglobin levels above 110 g/L. Patients who needed reoperation, combined procedures, or off-pump revascularization were excluded.
Results:
There was no hospital mortality. Mean chest tube losses after the surgical revascularization did not differ significantly, but group 1 received a higher quantity of transfused red blood cells and platelets.
Conclusion:
Urgent and emergent surgical revascularization using extracorporeal circulation in patients with acute coronary syndrome whose preoperative haemoglobin levels are above 110 g/L is a safe and effective procedure. We suggest that, where indicative, one may perform CABG in less than 5 days after the clopidogrel discontinuation.
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