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Impact of aspirin with or without clopidogrel on postoperative bleeding and blood transfusion in coronary surgical patients treated prophylactically with a low-dose of aprotinin.
Eur Heart J. 2007 Apr; 28(8):1025-32.EH

Abstract

AIMS

Aspirin combined with clopidogrel is the treatment of choice for acute coronary syndromes. Although the maintenance of aspirin until surgery does not affect postoperative bleeding after coronary artery bypass graft (CABG) surgery, the latter may be dramatically increased when clopidogrel is continued over a period of 5 days preoperatively.

METHODS AND RESULTS

This prospective observational study included 217 consecutive patients scheduled for first-time CABG. Postoperative bleeding and blood transfusion requirements were compared (equivalence) between patients pretreated during a period of 5 days prior surgery by either aspirin alone (n = 157) or combined with clopidogrel (n = 60). Aprotinin was systematically used in all these patients considered as high risk for bleeding. We found no significant difference between both groups concerning the preoperative characteristics except for unstable angina (33 vs. 19%, P = 0.02) and left main coronary artery stenosis (27 vs. 13%, P = 0.02), which were more frequent in patients receiving clopidogrel. The median chest tube output was similar in both groups 24 h postoperatively at 350 mL (95% CI 150-850) vs. 375 mL (95% CI 175-875), and the difference between groups (7%, 95% CI -9 to 22) did not encompass the predetermined margins of equivalence (25%). No significant difference was found on blood transfusion use (38 vs. 38%, P = 0.99). After adjustment by a propensity score, we found that clopidogrel was not associated with an increased risk of excessive bleeding.

CONCLUSION

In patients undergoing first-time CABG and treated prophylactically with aprotinin, aspirin and clopidogrel may be continued until surgery without increasing postoperative bleeding or transfusion requirements.

Authors+Show Affiliations

Department of Anaesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris, Paris, France. alexandre.ouattara@psl.aphp.frNo 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

17431000

Citation

Ouattara, Alexandre, et al. "Impact of Aspirin With or Without Clopidogrel On Postoperative Bleeding and Blood Transfusion in Coronary Surgical Patients Treated Prophylactically With a Low-dose of Aprotinin." European Heart Journal, vol. 28, no. 8, 2007, pp. 1025-32.
Ouattara A, Bouzguenda H, Le Manach Y, et al. Impact of aspirin with or without clopidogrel on postoperative bleeding and blood transfusion in coronary surgical patients treated prophylactically with a low-dose of aprotinin. Eur Heart J. 2007;28(8):1025-32.
Ouattara, A., Bouzguenda, H., Le Manach, Y., Léger, P., Mercadier, A., Leprince, P., Bonnet, N., Montalescot, G., Riou, B., & Coriat, P. (2007). Impact of aspirin with or without clopidogrel on postoperative bleeding and blood transfusion in coronary surgical patients treated prophylactically with a low-dose of aprotinin. European Heart Journal, 28(8), 1025-32.
Ouattara A, et al. Impact of Aspirin With or Without Clopidogrel On Postoperative Bleeding and Blood Transfusion in Coronary Surgical Patients Treated Prophylactically With a Low-dose of Aprotinin. Eur Heart J. 2007;28(8):1025-32. PubMed PMID: 17431000.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of aspirin with or without clopidogrel on postoperative bleeding and blood transfusion in coronary surgical patients treated prophylactically with a low-dose of aprotinin. AU - Ouattara,Alexandre, AU - Bouzguenda,Hassine, AU - Le Manach,Yannick, AU - Léger,Philippe, AU - Mercadier,Anne, AU - Leprince,Pascal, AU - Bonnet,Nicolas, AU - Montalescot,Gilles, AU - Riou,Bruno, AU - Coriat,Pierre, Y1 - 2007/04/12/ PY - 2007/4/14/pubmed PY - 2007/12/6/medline PY - 2007/4/14/entrez SP - 1025 EP - 32 JF - European heart journal JO - Eur Heart J VL - 28 IS - 8 N2 - AIMS: Aspirin combined with clopidogrel is the treatment of choice for acute coronary syndromes. Although the maintenance of aspirin until surgery does not affect postoperative bleeding after coronary artery bypass graft (CABG) surgery, the latter may be dramatically increased when clopidogrel is continued over a period of 5 days preoperatively. METHODS AND RESULTS: This prospective observational study included 217 consecutive patients scheduled for first-time CABG. Postoperative bleeding and blood transfusion requirements were compared (equivalence) between patients pretreated during a period of 5 days prior surgery by either aspirin alone (n = 157) or combined with clopidogrel (n = 60). Aprotinin was systematically used in all these patients considered as high risk for bleeding. We found no significant difference between both groups concerning the preoperative characteristics except for unstable angina (33 vs. 19%, P = 0.02) and left main coronary artery stenosis (27 vs. 13%, P = 0.02), which were more frequent in patients receiving clopidogrel. The median chest tube output was similar in both groups 24 h postoperatively at 350 mL (95% CI 150-850) vs. 375 mL (95% CI 175-875), and the difference between groups (7%, 95% CI -9 to 22) did not encompass the predetermined margins of equivalence (25%). No significant difference was found on blood transfusion use (38 vs. 38%, P = 0.99). After adjustment by a propensity score, we found that clopidogrel was not associated with an increased risk of excessive bleeding. CONCLUSION: In patients undergoing first-time CABG and treated prophylactically with aprotinin, aspirin and clopidogrel may be continued until surgery without increasing postoperative bleeding or transfusion requirements. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/17431000/Impact_of_aspirin_with_or_without_clopidogrel_on_postoperative_bleeding_and_blood_transfusion_in_coronary_surgical_patients_treated_prophylactically_with_a_low_dose_of_aprotinin_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehm049 DB - PRIME DP - Unbound Medicine ER -