Tags

Type your tag names separated by a space and hit enter

Does clopidogrel increase blood loss following coronary artery bypass surgery?
Ann Thorac Surg. 2004 Nov; 78(5):1536-41.AT

Abstract

BACKGROUND

Clopidogrel (Plavix) is a potent inhibitor of platelet aggregation used concomitantly with percutaneous coronary interventions and in patients with acute coronary syndromes. Its favorable effects on preventing thrombus formation may have deleterious effects on hemostasis in patients undergoing coronary surgery.

METHODS

Data were collected prospectively on 312 consecutive urgent or emergent coronary artery bypass patients from July 1999 through April 2001 at a tertiary care center. Patients were stratified into three groups: clopidogrel within 4 days of operation (n = 41), clopidogrel continued until 5 to 8 days before operation (n = 39), and clopidogrel discontinued more than 8 days before operation or were never taking clopidogrel (n = 232).

RESULTS

Preoperative and intraoperative characteristics were similar among all groups. Mediastinal and pericardial chest tube losses in the first 24 hours were 1,044 +/- 750 mL in the clopidogrel within 4 days group, 528 +/- 250 mL in the clopidogrel 5 to 8 days group, and 573 +/- 329 mL in the clopidogrel more than 8 days group (p < 0.01). The mean total blood product transfusions were 12.2 +/- 15.4 U, 1.2 +/- 2.0 U, and 2.6 +/- 5.7 U, respectively (p < 0.001). Reoperation for bleeding was noted in 14.6%, 2.6%, and 1.7%, respectively (p = 0.002). The median hospital lengths of stay for the three groups were 9 days, 7 days, and 7 days, respectively (p = 0.018). There were no statistically significant differences in mortality rate, myocardial infarction, stroke, mediastinitis, or postoperative renal failure among the groups. Multivariable analysis revealed that clopidogrel within 0 to 4 days of operation was an independent predictor of transfusion requirements (OR 4.22, 95% confidence interval [CI] 2.07, 9.34, p = 0.001), intensive care unit (ICU) length of stay (OR 3.14, 95% CI 1.40, 7.04, p = 0.006), and total hospital length of stay (coefficient 7.65, se 2.41, p = 0.002).

CONCLUSIONS

Clopidogrel within 4 days of coronary bypass surgery is associated with increased blood losses and reoperation for bleeding and, according to multivariable models, is an independent risk factor for increased transfusion requirements and prolonged ICU and hospital length of stay.

Authors+Show Affiliations

Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15511426

Citation

Chu, Michael W A., et al. "Does Clopidogrel Increase Blood Loss Following Coronary Artery Bypass Surgery?" The Annals of Thoracic Surgery, vol. 78, no. 5, 2004, pp. 1536-41.
Chu MW, Wilson SR, Novick RJ, et al. Does clopidogrel increase blood loss following coronary artery bypass surgery? Ann Thorac Surg. 2004;78(5):1536-41.
Chu, M. W., Wilson, S. R., Novick, R. J., Stitt, L. W., & Quantz, M. A. (2004). Does clopidogrel increase blood loss following coronary artery bypass surgery? The Annals of Thoracic Surgery, 78(5), 1536-41.
Chu MW, et al. Does Clopidogrel Increase Blood Loss Following Coronary Artery Bypass Surgery. Ann Thorac Surg. 2004;78(5):1536-41. PubMed PMID: 15511426.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does clopidogrel increase blood loss following coronary artery bypass surgery? AU - Chu,Michael W A, AU - Wilson,Steve R, AU - Novick,Richard J, AU - Stitt,Larry W, AU - Quantz,MacKenzie A, PY - 2004/03/08/accepted PY - 2004/10/30/pubmed PY - 2005/2/5/medline PY - 2004/10/30/entrez SP - 1536 EP - 41 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 78 IS - 5 N2 - BACKGROUND: Clopidogrel (Plavix) is a potent inhibitor of platelet aggregation used concomitantly with percutaneous coronary interventions and in patients with acute coronary syndromes. Its favorable effects on preventing thrombus formation may have deleterious effects on hemostasis in patients undergoing coronary surgery. METHODS: Data were collected prospectively on 312 consecutive urgent or emergent coronary artery bypass patients from July 1999 through April 2001 at a tertiary care center. Patients were stratified into three groups: clopidogrel within 4 days of operation (n = 41), clopidogrel continued until 5 to 8 days before operation (n = 39), and clopidogrel discontinued more than 8 days before operation or were never taking clopidogrel (n = 232). RESULTS: Preoperative and intraoperative characteristics were similar among all groups. Mediastinal and pericardial chest tube losses in the first 24 hours were 1,044 +/- 750 mL in the clopidogrel within 4 days group, 528 +/- 250 mL in the clopidogrel 5 to 8 days group, and 573 +/- 329 mL in the clopidogrel more than 8 days group (p < 0.01). The mean total blood product transfusions were 12.2 +/- 15.4 U, 1.2 +/- 2.0 U, and 2.6 +/- 5.7 U, respectively (p < 0.001). Reoperation for bleeding was noted in 14.6%, 2.6%, and 1.7%, respectively (p = 0.002). The median hospital lengths of stay for the three groups were 9 days, 7 days, and 7 days, respectively (p = 0.018). There were no statistically significant differences in mortality rate, myocardial infarction, stroke, mediastinitis, or postoperative renal failure among the groups. Multivariable analysis revealed that clopidogrel within 0 to 4 days of operation was an independent predictor of transfusion requirements (OR 4.22, 95% confidence interval [CI] 2.07, 9.34, p = 0.001), intensive care unit (ICU) length of stay (OR 3.14, 95% CI 1.40, 7.04, p = 0.006), and total hospital length of stay (coefficient 7.65, se 2.41, p = 0.002). CONCLUSIONS: Clopidogrel within 4 days of coronary bypass surgery is associated with increased blood losses and reoperation for bleeding and, according to multivariable models, is an independent risk factor for increased transfusion requirements and prolonged ICU and hospital length of stay. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/15511426/Does_clopidogrel_increase_blood_loss_following_coronary_artery_bypass_surgery L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003497504006472 DB - PRIME DP - Unbound Medicine ER -