Related Experiment Video
Updated: Jan 21, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Association among Clopidogrel Cessation, Platelet Function, and Bleeding in Coronary Bypass Surgery: An Observational
Mate Petricevic1, Jadranka Knezevic2, Bojan Biocina1
1Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
Insights
A longer clopidogrel-free interval before coronary artery bypass grafting (CABG) surgery reduces postoperative bleeding and transfusion needs. Platelet function testing can help manage bleeding risk in these patients.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Pharmacology
Background:
- Clopidogrel is an antiplatelet medication commonly used in patients with coronary artery disease.
- Discontinuation of clopidogrel before surgery is necessary to reduce bleeding risk, but the optimal duration is debated.
- Coronary artery bypass grafting (CABG) surgery carries a significant risk of bleeding and requires transfusions.
Purpose of the Study:
- To investigate the association between the duration of preoperative clopidogrel discontinuation and postoperative blood loss and transfusion requirements in CABG patients.
- To determine if preoperative platelet function testing can predict excessive bleeding after CABG surgery.
Main Methods:
- Retrospective analysis of 94 patients (≤3 days), 100 patients (4-5 days), and 83 patients (6-7 days) undergoing CABG, grouped by clopidogrel cessation interval.
- Preoperative platelet function assessed using impedance aggregometry (Multiplate) with arachidonic acid (ASPI) and adenosine diphosphate (ADP) tests.
- Primary outcome: 24-hour chest tube output (CTO); Secondary outcomes: transfusion requirements (red blood cell concentrate [RBCC], platelet concentrate [PC], fibrinogen concentrate [FC], fresh-frozen plasma [FFP]).
Main Results:
- Significantly higher 24-hour CTO in the ≤3-day clopidogrel cessation group compared to longer intervals (p=0.003).
- Increased transfusion of RBCC (p=0.043), PC (p=0.001), FC (p=0.003), and FFP (p=0.010) in the ≤3-day group.
- ASPI and ADP tests correlated with CTO (p<0.001 and p=0.007, respectively); clopidogrel-free interval correlated with CTO (p<0.001).
- ROC analysis identified cutoff values for bleeding risk: ASPI test ≤25 AUC, ADP test ≤63 AUC, and clopidogrel-free interval ≤3 days.
Conclusions:
- Less postoperative bleeding in CABG patients with clopidogrel discontinuation >3 days compared to shorter intervals.
- Impaired platelet function recovery post-clopidogrel cessation is linked to increased bleeding risk.
- Platelet function testing is a valuable tool for managing postoperative bleeding risk in CABG patients.
Objectives:
This study sought to determine (1) the association between the length of preoperative clopidogrel discontinuation, blood loss, and transfusion requirements and (2) whether preoperative platelet function testing predicts excessive postoperative bleeding in patients undergoing coronary artery bypass grafting (CABG) surgery.
Methods:
In this retrospective analysis, patients undergoing CABG were divided into three groups with regard to the period between preoperative clopidogrel cessation and surgery: group 1 (n = 94, ≤3 days), group 2 (n = 100, 4-5 days), and group 3 (n = 83, 6-7 days), respectively. Impedance aggregometry (Multiplate) with arachidonic acid (ASPI) test assay (used for platelets stimulation) and adenosine diphosphate (ADP) test (used for platelets stimulation) was performed before the surgery. Primary outcome was 24 hours chest tube output (CTO) and transfusion requirements (red blood cell concentrate [RBCC], platelet concentrate [PC], fibrinogen concentrate [FC], and fresh-frozen plasma [FFP]) were considered as secondary outcomes.
Results:
CTO during 24 hours was significantly higher in group 1 as compared with groups 2 and 3, respectively (p = 0.003). Considering secondary outcomes, RBCC (p = 0.043), PC (p = 0.001), FC (p = 0.003), and FFP (p = 0.010) were more frequently transfused in group 1 as compared with groups 2 and 3, respectively. Multiple electrode aggregometry ASPI and ADP tests were significantly correlated with the 24-hour CTO (ASPI test-rho = -0.258, p < 0.001; ADP test-rho = -0.164, p = 0.007). A significant correlation was observed between clopidogrel-free interval and 24-hour CTO (rho = -0.200, p < 0.001). Receiver-operating characteristics (ROC) curve analysis revealed cutoff values to delineate bleeding tendency (ASPI test ≤ 25 area under the aggregation curve [AUC], ADP test ≤63 AUC, and clopidogrel-free interval ≤3 days).
Conclusion:
Excessive postoperative bleeding occurred less frequently if the period between clopidogrel discontinuation and surgery was longer than 3 days, as compared with shorter waiting time. Inadequate recovery of the platelets function following clopidogrel cessation in preoperative period was associated with increased bleeding risk. Platelet function testing was found to be a useful tool for postoperative bleeding management in our hands.
Related Concept Videos
01:18Structure and Function of Platelets
Platelets are continually replenished, circulating in the bloodstream for 9-12 days before being removed by phagocytes, primarily in the spleen. A microliter of circulating blood contains between 150,000 and 450,000...
01:22Bleeding in Fresh Concrete
Bleeding can cause several issues in the concrete structure. Sometimes, the rising water gets trapped beneath large aggregate...
01:16Clinical Trials
There are four phases in a clinical trial. A phase one...
01:11Clinical Trials: Overview
01:12Trial and Error and Algorithm
01:21Association Areas of the Cortex
Prefrontal Association Area: This area is located in the frontal lobe and is involved in planning, decision-making, and moderating social behavior. It connects with primary motor areas,...