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Effect of clopidogrel premedication in off-pump cardiac surgery: are we forfeiting the benefits of reduced hemorrhagic sequelae?
Circulation. 2006 Apr 04; 113(13):1667-74.Circ

Abstract

BACKGROUND

Premedication with clopidogrel has reduced thrombotic complications after percutaneous coronary revascularization procedures. However, because of the enhanced and irreversible platelet inhibition by clopidogrel, patients requiring surgical revascularization have a higher risk of bleeding complications and transfusion requirements. A principal benefit of surgical coronary revascularization without cardiopulmonary bypass is its lower hemorrhagic sequelae. The purpose of this study was to evaluate the effect of preoperative clopidogrel administration in the incidence of hemostatic reexploration, blood product transfusion rates, morbidity, and mortality in patients undergoing off-pump coronary artery bypass graft surgery using a large patient sample and a risk-adjusted approach.

METHODS AND RESULTS

Two hundred eighty-one patients (17.9%) did and 1291 (82.1%) did not receive clopidogrel before their surgery, for a total of 1572 patients undergoing isolated off-pump coronary artery bypass graft surgery between January 2000 and June 2002. Risk-adjusted logistic regression analyses and a matched pair analyses by propensity scores were used to assess the association between clopidogrel administration and reoperation as a result of bleeding, intraoperative and postoperative blood transfusions received, and the need for multiple transfusions. Hemorrhage-related preoperative risk factors identified in the literature and those found significant in a univariate model were used. The clopidogrel group had a higher likelihood of hemostatic reoperations (odds ratio [OR], 5.1; 95% confidence interval [CI], 2.47 to 10.47; P<0.01) and an increased need in overall packed red blood cell (OR, 2.6; 95% CI, 1.94 to 3.60; P<0.01), multiple unit (OR, 1.6; 95% CI, 1.07 to 2.48; P=0.02), and platelet (OR, 2.5; 95% CI, 1.77 to 3.66; P<0.01) transfusions. Surgical outcomes and operative mortality (1.4% versus 1.4%; P=1.00) were not statistically different.

CONCLUSIONS

Clopidogrel administration in the cardiology suite increases the risk for hemostatic reoperation and the requirements for blood product transfusions during and after off-pump coronary artery bypass graft surgery.

Authors+Show Affiliations

Department of Surgery, Washington Hospital Center, Washington, DC 20010-2975, USA. emmanouil.kapetanakis@medstar.netNo 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

16567570

Citation

Kapetanakis, Emmanouil I., et al. "Effect of Clopidogrel Premedication in Off-pump Cardiac Surgery: Are We Forfeiting the Benefits of Reduced Hemorrhagic Sequelae?" Circulation, vol. 113, no. 13, 2006, pp. 1667-74.
Kapetanakis EI, Medlam DA, Petro KR, et al. Effect of clopidogrel premedication in off-pump cardiac surgery: are we forfeiting the benefits of reduced hemorrhagic sequelae? Circulation. 2006;113(13):1667-74.
Kapetanakis, E. I., Medlam, D. A., Petro, K. R., Haile, E., Hill, P. C., Dullum, M. K., Bafi, A. S., Boyce, S. W., & Corso, P. J. (2006). Effect of clopidogrel premedication in off-pump cardiac surgery: are we forfeiting the benefits of reduced hemorrhagic sequelae? Circulation, 113(13), 1667-74.
Kapetanakis EI, et al. Effect of Clopidogrel Premedication in Off-pump Cardiac Surgery: Are We Forfeiting the Benefits of Reduced Hemorrhagic Sequelae. Circulation. 2006 Apr 4;113(13):1667-74. PubMed PMID: 16567570.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of clopidogrel premedication in off-pump cardiac surgery: are we forfeiting the benefits of reduced hemorrhagic sequelae? AU - Kapetanakis,Emmanouil I, AU - Medlam,Diego A, AU - Petro,Kathleen R, AU - Haile,Elizabeth, AU - Hill,Peter C, AU - Dullum,Mercedes K C, AU - Bafi,Ammar S, AU - Boyce,Steven W, AU - Corso,Paul J, Y1 - 2006/03/27/ PY - 2006/3/29/pubmed PY - 2006/4/19/medline PY - 2006/3/29/entrez SP - 1667 EP - 74 JF - Circulation JO - Circulation VL - 113 IS - 13 N2 - BACKGROUND: Premedication with clopidogrel has reduced thrombotic complications after percutaneous coronary revascularization procedures. However, because of the enhanced and irreversible platelet inhibition by clopidogrel, patients requiring surgical revascularization have a higher risk of bleeding complications and transfusion requirements. A principal benefit of surgical coronary revascularization without cardiopulmonary bypass is its lower hemorrhagic sequelae. The purpose of this study was to evaluate the effect of preoperative clopidogrel administration in the incidence of hemostatic reexploration, blood product transfusion rates, morbidity, and mortality in patients undergoing off-pump coronary artery bypass graft surgery using a large patient sample and a risk-adjusted approach. METHODS AND RESULTS: Two hundred eighty-one patients (17.9%) did and 1291 (82.1%) did not receive clopidogrel before their surgery, for a total of 1572 patients undergoing isolated off-pump coronary artery bypass graft surgery between January 2000 and June 2002. Risk-adjusted logistic regression analyses and a matched pair analyses by propensity scores were used to assess the association between clopidogrel administration and reoperation as a result of bleeding, intraoperative and postoperative blood transfusions received, and the need for multiple transfusions. Hemorrhage-related preoperative risk factors identified in the literature and those found significant in a univariate model were used. The clopidogrel group had a higher likelihood of hemostatic reoperations (odds ratio [OR], 5.1; 95% confidence interval [CI], 2.47 to 10.47; P<0.01) and an increased need in overall packed red blood cell (OR, 2.6; 95% CI, 1.94 to 3.60; P<0.01), multiple unit (OR, 1.6; 95% CI, 1.07 to 2.48; P=0.02), and platelet (OR, 2.5; 95% CI, 1.77 to 3.66; P<0.01) transfusions. Surgical outcomes and operative mortality (1.4% versus 1.4%; P=1.00) were not statistically different. CONCLUSIONS: Clopidogrel administration in the cardiology suite increases the risk for hemostatic reoperation and the requirements for blood product transfusions during and after off-pump coronary artery bypass graft surgery. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/16567570/Effect_of_clopidogrel_premedication_in_off_pump_cardiac_surgery:_are_we_forfeiting_the_benefits_of_reduced_hemorrhagic_sequelae L2 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.105.571828?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -