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Clopidogrel administration prior to coronary artery bypass grafting surgery: the cardiologist's panacea or the surgeon's headache?
Eur Heart J. 2005 Mar; 26(6):576-83.EH

Abstract

AIMS

Thrombotic complications after percutaneous coronary intervention procedures have decreased in past years mainly due to the use of clopidogrel antiplatelet therapy. However, the risk of bleeding due to enhanced and irreversible platelet inhibition in patients who will require surgical coronary revascularization instead has not been adequately addressed in the literature. The purpose of this study was to evaluate the effect of pre-operative clopidrogel exposure in haemorrhage-related re-exploration rates, peri-operative transfusion requirements, morbidity, and mortality in patients undergoing coronary artery bypass grafting (CABG) surgery.

METHODS AND RESULTS

A study population of 2359 patients undergoing isolated CABG between January 2000 and June 2002 was reviewed. Of these, 415 (17.6%) received clopidogrel prior to CABG surgery, and 1944 (82.4%) did not. A risk-adjusted logistic regression analysis was used to assess the association between clopidogrel pre-medication (vs. no) and haemostatic re-operation, intraoperative and post-operative blood transfusion rates, and multiple transfusions received. Haemorrhage-related pre-operative risk factors identified from the literature and those found significant in a univariate model were used. Furthermore, a sub-cohort, matched-pair by propensity scores analysis, was also conducted. The clopidogrel group had a higher likelihood of haemostatic re-operation [OR = 4.9, (95% CI, 2.63-8.97), P < 0.01], an increase in total packed red blood cell transfusions [OR = 2.2, (95% CI, 1.70-2.84), P < 0.01], multiple unit blood transfusions [OR = 1.9, (95% CI, 1.33-2.75), P < 0.01] and platelet transfusions [OR = 2.6, (95% CI, 1.95-3.56), P < 0.01]. Surgical outcomes and operative mortality [OR = 1.5, (95% CI, 0.36-6.51), P = 0.56] were not significantly different.

CONCLUSION

Pre-operative clopidogrel exposure increases the risk of haemostatic re-operation and the requirements for blood and blood product transfusion during, and after, CABG surgery.

Authors+Show Affiliations

Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center, 106 Irving Street, NW, Suite 316, Washington, DC 20010-2975, USA. emmanouil_kapetanakis@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15723815

Citation

Kapetanakis, Emmanouil I., et al. "Clopidogrel Administration Prior to Coronary Artery Bypass Grafting Surgery: the Cardiologist's Panacea or the Surgeon's Headache?" European Heart Journal, vol. 26, no. 6, 2005, pp. 576-83.
Kapetanakis EI, Medlam DA, Boyce SW, et al. Clopidogrel administration prior to coronary artery bypass grafting surgery: the cardiologist's panacea or the surgeon's headache? Eur Heart J. 2005;26(6):576-83.
Kapetanakis, E. I., Medlam, D. A., Boyce, S. W., Haile, E., Hill, P. C., Dullum, M. K., Bafi, A. S., Petro, K. R., & Corso, P. J. (2005). Clopidogrel administration prior to coronary artery bypass grafting surgery: the cardiologist's panacea or the surgeon's headache? European Heart Journal, 26(6), 576-83.
Kapetanakis EI, et al. Clopidogrel Administration Prior to Coronary Artery Bypass Grafting Surgery: the Cardiologist's Panacea or the Surgeon's Headache. Eur Heart J. 2005;26(6):576-83. PubMed PMID: 15723815.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clopidogrel administration prior to coronary artery bypass grafting surgery: the cardiologist's panacea or the surgeon's headache? AU - Kapetanakis,Emmanouil I, AU - Medlam,Diego A, AU - Boyce,Steven W, AU - Haile,Elizabeth, AU - Hill,Peter C, AU - Dullum,Mercedes K C, AU - Bafi,Ammar S, AU - Petro,Kathleen R, AU - Corso,Paul J, Y1 - 2005/02/21/ PY - 2005/2/23/pubmed PY - 2005/6/17/medline PY - 2005/2/23/entrez SP - 576 EP - 83 JF - European heart journal JO - Eur Heart J VL - 26 IS - 6 N2 - AIMS: Thrombotic complications after percutaneous coronary intervention procedures have decreased in past years mainly due to the use of clopidogrel antiplatelet therapy. However, the risk of bleeding due to enhanced and irreversible platelet inhibition in patients who will require surgical coronary revascularization instead has not been adequately addressed in the literature. The purpose of this study was to evaluate the effect of pre-operative clopidrogel exposure in haemorrhage-related re-exploration rates, peri-operative transfusion requirements, morbidity, and mortality in patients undergoing coronary artery bypass grafting (CABG) surgery. METHODS AND RESULTS: A study population of 2359 patients undergoing isolated CABG between January 2000 and June 2002 was reviewed. Of these, 415 (17.6%) received clopidogrel prior to CABG surgery, and 1944 (82.4%) did not. A risk-adjusted logistic regression analysis was used to assess the association between clopidogrel pre-medication (vs. no) and haemostatic re-operation, intraoperative and post-operative blood transfusion rates, and multiple transfusions received. Haemorrhage-related pre-operative risk factors identified from the literature and those found significant in a univariate model were used. Furthermore, a sub-cohort, matched-pair by propensity scores analysis, was also conducted. The clopidogrel group had a higher likelihood of haemostatic re-operation [OR = 4.9, (95% CI, 2.63-8.97), P < 0.01], an increase in total packed red blood cell transfusions [OR = 2.2, (95% CI, 1.70-2.84), P < 0.01], multiple unit blood transfusions [OR = 1.9, (95% CI, 1.33-2.75), P < 0.01] and platelet transfusions [OR = 2.6, (95% CI, 1.95-3.56), P < 0.01]. Surgical outcomes and operative mortality [OR = 1.5, (95% CI, 0.36-6.51), P = 0.56] were not significantly different. CONCLUSION: Pre-operative clopidogrel exposure increases the risk of haemostatic re-operation and the requirements for blood and blood product transfusion during, and after, CABG surgery. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/15723815/Clopidogrel_administration_prior_to_coronary_artery_bypass_grafting_surgery:_the_cardiologist's_panacea_or_the_surgeon's_headache L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehi074 DB - PRIME DP - Unbound Medicine ER -