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Acute clopidogrel use and outcomes in patients with non-ST-segment elevation acute coronary syndromes undergoing coronary artery bypass surgery.
J Am Coll Cardiol 2006; 48(2):281-6JACC

Abstract

OBJECTIVES

We sought to characterize patterns of clopidogrel use before coronary artery bypass grafting (CABG) and examine the drug's impact on risks for postoperative transfusions among patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS).

BACKGROUND

Adherence in community practice to American College of Cardiology/American Heart Association guidelines for clopidogrel use among NSTE ACS patients has not been previously characterized.

METHODS

We evaluated 2,858 NSTE ACS patients undergoing CABG at 264 hospitals participating in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Initiative. We examined the patterns of acute clopidogrel therapy and its association with bleeding risks among those having "early" CABG < or =5 days and again among those having "late" surgery >5 days after catheterization.

RESULTS

Within 24 h of admission, 852 patients (30%) received clopidogrel. In contrast to national guidelines, 87% of clopidogrel-treated patients underwent CABG < or =5 days after treatment. Among those receiving CABG within < or =5 days of last treatment, the use of clopidogrel was associated with a significant increase in blood transfusions (65.0% vs. 56.9%, adjusted odds ratio [OR] 1.36, 95% confidence interval [CI] 1.10 to 1.68) as well as the need for transfusion of > or =4 U of blood (27.7% vs. 18.4%, OR 1.70, 95% CI 1.32 to 2.19). In contrast, acute clopidogrel therapy was not associated with higher bleeding risks if CABG was delayed >5 days (adjusted OR 1.18, 95% CI 0.54 to 2.58).

CONCLUSIONS

Despite guideline recommendations, the overwhelming majority of NSTE ACS patients treated with acute clopidogrel needing CABG have their surgery within < or =5 days of treatment. A failure to delay surgery is associated with increased blood transfusion requirements that must be weighed against the potential clinical and economic impacts of such delays.

Authors+Show Affiliations

Division of Cardiology and the Duke Clinical Research Institute, Durham, North Carolina 27715, USA. mehta007@dcri.duke.eduNo affiliation info availableNo 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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16843176

Citation

Mehta, Rajendra H., et al. "Acute Clopidogrel Use and Outcomes in Patients With non-ST-segment Elevation Acute Coronary Syndromes Undergoing Coronary Artery Bypass Surgery." Journal of the American College of Cardiology, vol. 48, no. 2, 2006, pp. 281-6.
Mehta RH, Roe MT, Mulgund J, et al. Acute clopidogrel use and outcomes in patients with non-ST-segment elevation acute coronary syndromes undergoing coronary artery bypass surgery. J Am Coll Cardiol. 2006;48(2):281-6.
Mehta, R. H., Roe, M. T., Mulgund, J., Ohman, E. M., Cannon, C. P., Gibler, W. B., ... Peterson, E. D. (2006). Acute clopidogrel use and outcomes in patients with non-ST-segment elevation acute coronary syndromes undergoing coronary artery bypass surgery. Journal of the American College of Cardiology, 48(2), pp. 281-6.
Mehta RH, et al. Acute Clopidogrel Use and Outcomes in Patients With non-ST-segment Elevation Acute Coronary Syndromes Undergoing Coronary Artery Bypass Surgery. J Am Coll Cardiol. 2006 Jul 18;48(2):281-6. PubMed PMID: 16843176.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute clopidogrel use and outcomes in patients with non-ST-segment elevation acute coronary syndromes undergoing coronary artery bypass surgery. AU - Mehta,Rajendra H, AU - Roe,Matthew T, AU - Mulgund,Jyotsna, AU - Ohman,E Magnus, AU - Cannon,Christopher P, AU - Gibler,W Brian, AU - Pollack,Charles V,Jr AU - Smith,Sidney C,Jr AU - Ferguson,T Bruce, AU - Peterson,Eric D, Y1 - 2006/06/21/ PY - 2005/08/30/received PY - 2006/03/17/revised PY - 2006/03/21/accepted PY - 2006/7/18/pubmed PY - 2006/8/23/medline PY - 2006/7/18/entrez SP - 281 EP - 6 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 48 IS - 2 N2 - OBJECTIVES: We sought to characterize patterns of clopidogrel use before coronary artery bypass grafting (CABG) and examine the drug's impact on risks for postoperative transfusions among patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). BACKGROUND: Adherence in community practice to American College of Cardiology/American Heart Association guidelines for clopidogrel use among NSTE ACS patients has not been previously characterized. METHODS: We evaluated 2,858 NSTE ACS patients undergoing CABG at 264 hospitals participating in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Initiative. We examined the patterns of acute clopidogrel therapy and its association with bleeding risks among those having "early" CABG < or =5 days and again among those having "late" surgery >5 days after catheterization. RESULTS: Within 24 h of admission, 852 patients (30%) received clopidogrel. In contrast to national guidelines, 87% of clopidogrel-treated patients underwent CABG < or =5 days after treatment. Among those receiving CABG within < or =5 days of last treatment, the use of clopidogrel was associated with a significant increase in blood transfusions (65.0% vs. 56.9%, adjusted odds ratio [OR] 1.36, 95% confidence interval [CI] 1.10 to 1.68) as well as the need for transfusion of > or =4 U of blood (27.7% vs. 18.4%, OR 1.70, 95% CI 1.32 to 2.19). In contrast, acute clopidogrel therapy was not associated with higher bleeding risks if CABG was delayed >5 days (adjusted OR 1.18, 95% CI 0.54 to 2.58). CONCLUSIONS: Despite guideline recommendations, the overwhelming majority of NSTE ACS patients treated with acute clopidogrel needing CABG have their surgery within < or =5 days of treatment. A failure to delay surgery is associated with increased blood transfusion requirements that must be weighed against the potential clinical and economic impacts of such delays. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/16843176/Acute_clopidogrel_use_and_outcomes_in_patients_with_non_ST_segment_elevation_acute_coronary_syndromes_undergoing_coronary_artery_bypass_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(06)01050-3 DB - PRIME DP - Unbound Medicine ER -