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Published on: September 15, 2023
Effect of Preoperative Clopidogrel on Outcomes of Isolated Coronary Artery Bypass Graft: An STS National Database
Kukbin Choi1, Hartzell V Schaff1, Mauricio A Villavicencio1
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Insights
Coronary artery bypass grafting (CABG) within 5 days of clopidogrel increases operative mortality and bleeding reexploration. Waiting 3 days after clopidogrel offers similar outcomes to 5 days, reducing wait times.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Clopidogrel is an antiplatelet medication frequently used in patients with coronary artery disease.
- Determining the optimal timing for coronary artery bypass grafting (CABG) after clopidogrel administration is crucial for patient safety.
- The Society of Thoracic Surgeons Database provides a large dataset for investigating surgical outcomes.
Purpose of the Study:
- To investigate the risks associated with coronary artery bypass grafting (CABG) performed within 5 days of clopidogrel administration.
- To determine the optimal timing for CABG after clopidogrel discontinuation to minimize adverse outcomes.
- To compare outcomes of CABG at different time intervals after clopidogrel use.
Main Methods:
- Analysis of The Society of Thoracic Surgeons Database.
- Categorization of patients based on clopidogrel use within 5 days of isolated CABG.
- Stratification by days from last clopidogrel dose (0-5 days) and comparison with a control group (no clopidogrel within 5 days).
- Primary outcome: operative mortality. Secondary outcomes: mediastinal reexploration for bleeding, blood product use.
Main Results:
- 13.2% of 148,317 isolated CABG patients received clopidogrel within 5 days.
- Clopidogrel use was associated with higher rates of mediastinal reexploration (3.5% vs 2.1%) and blood product utilization (72.7% vs 56.8%).
- Operative mortality showed minimal differences (2.8% vs 2.1%), but peaked on the day of clopidogrel administration, plateauing after 3 days.
- CABG at 3 days post-clopidogrel had similar mortality and reexploration rates as at 5 days, with shorter hospital stays but higher blood product use.
Conclusions:
- CABG within 5 days of clopidogrel is linked to increased operative mortality, bleeding reexploration, and substantial blood product use.
- Surgical risks decrease with time from clopidogrel discontinuation, plateauing after 3 days.
- Performing CABG 3 days after clopidogrel offers comparable safety to 5 days, potentially reducing the necessary waiting period.
Background:
We analyzed The Society of Thoracic Surgeons Database to investigate risks and optimal timing for coronary artery bypass grafting (CABG) after clopidogrel administration.
Methods:
Patients were categorized based on clopidogrel use within 5 days and further stratified by days from the last dose (0 to 5 days). Controls were patients who did not receive clopidogrel within 5 days of surgery. The primary outcome was operative mortality, and secondary outcomes included mediastinal reexploration for bleeding and blood product use.
Results:
Among 148,317 isolated CABG, 19,553 patients (13.2%) received clopidogrel within 5 days. Minimal differences in operative mortality (2.8% vs 2.1%, P < .001), but higher rates of mediastinal reexploration (3.5% vs 2.1%, P < .001) and blood product utilization (72.7% vs 56.8%, P < .001) were observed in the clopidogrel group. The adjusted odds ratio of operative mortality peaked on the day of clopidogrel administration but was comparable to controls thereafter. The odds of reexploration were highest on day 0, decreasing gradually to a plateau after day 3. Patients who underwent operations on day 3 after clopidogrel administration had similar odds of operative mortality and mediastinal reexploration for bleeding and shorter total and preoperative lengths of stay but higher blood product use compared with day 5.
Conclusions:
CABG within 5 days from clopidogrel is associated with a modest increase in operative mortality and reexploration for bleeding and a substantial increase in blood product use. Risks decreased with increasing time from discontinuation, plateauing after 3 days from clopidogrel. CABG at 3 days yields comparable outcomes as 5 days, reducing the waiting period.
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