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Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery.
J Thorac Cardiovasc Surg. 2007 Jul; 134(1):59-64.JT

Abstract

OBJECTIVE

Preoperative exposure to clopidogrel and aspirin significantly increases postoperative bleeding in patients undergoing on-pump coronary artery bypass graft surgery. Off-pump coronary bypass grafting has been proposed as an alternative technique to attenuate postoperative bleeding associated with clopidogrel. This study aimed to determine the effects of aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in off-pump coronary artery bypass grafting.

METHODS

One hundred six patients scheduled for off-pump coronary artery bypass grafting were divided into three groups: aspirin and clopidogrel discontinued more than 6 days before surgery (group 1, n = 35), aspirin and clopidogrel continued until 3 to 5 days before surgery (group 2, n = 51), and both medications continued within 2 days of surgery (group 3, n = 20). Thromboelastographic tracings were analyzed before induction of anesthesia. Routine coagulation profiles were measured before and after surgery. A cell salvage device was used during surgery and salvaged blood was reinfused. Chest tube drainage and blood transfusion requirement were recorded postoperatively.

RESULTS

Patient characteristics, operative data, and thromboelastographic tracings were similar among the groups. There were significant decreases in hematocrit level and platelet count and prolongation in prothrombin time postoperatively in all groups without any intergroup differences. The amounts of perioperative blood loss and blood transfusion required were all similar among the groups.

CONCLUSION

Preoperative clopidogrel and aspirin exposure even within 2 days of surgery does not increase perioperative blood loss and blood transfusion requirements in patients undergoing elective off-pump coronary artery bypass grafting.

Authors+Show Affiliations

Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

17599487

Citation

Shim, Jae Kwang, et al. "Effects of Preoperative Aspirin and Clopidogrel Therapy On Perioperative Blood Loss and Blood Transfusion Requirements in Patients Undergoing Off-pump Coronary Artery Bypass Graft Surgery." The Journal of Thoracic and Cardiovascular Surgery, vol. 134, no. 1, 2007, pp. 59-64.
Shim JK, Choi YS, Oh YJ, et al. Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 2007;134(1):59-64.
Shim, J. K., Choi, Y. S., Oh, Y. J., Bang, S. O., Yoo, K. J., & Kwak, Y. L. (2007). Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery. The Journal of Thoracic and Cardiovascular Surgery, 134(1), 59-64.
Shim JK, et al. Effects of Preoperative Aspirin and Clopidogrel Therapy On Perioperative Blood Loss and Blood Transfusion Requirements in Patients Undergoing Off-pump Coronary Artery Bypass Graft Surgery. J Thorac Cardiovasc Surg. 2007;134(1):59-64. PubMed PMID: 17599487.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery. AU - Shim,Jae Kwang, AU - Choi,Yong Seon, AU - Oh,Young Jun, AU - Bang,Sou Ouk, AU - Yoo,Kyung Jong, AU - Kwak,Young Lan, PY - 2006/11/17/received PY - 2007/03/02/revised PY - 2007/03/15/accepted PY - 2007/6/30/pubmed PY - 2007/7/25/medline PY - 2007/6/30/entrez SP - 59 EP - 64 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 134 IS - 1 N2 - OBJECTIVE: Preoperative exposure to clopidogrel and aspirin significantly increases postoperative bleeding in patients undergoing on-pump coronary artery bypass graft surgery. Off-pump coronary bypass grafting has been proposed as an alternative technique to attenuate postoperative bleeding associated with clopidogrel. This study aimed to determine the effects of aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in off-pump coronary artery bypass grafting. METHODS: One hundred six patients scheduled for off-pump coronary artery bypass grafting were divided into three groups: aspirin and clopidogrel discontinued more than 6 days before surgery (group 1, n = 35), aspirin and clopidogrel continued until 3 to 5 days before surgery (group 2, n = 51), and both medications continued within 2 days of surgery (group 3, n = 20). Thromboelastographic tracings were analyzed before induction of anesthesia. Routine coagulation profiles were measured before and after surgery. A cell salvage device was used during surgery and salvaged blood was reinfused. Chest tube drainage and blood transfusion requirement were recorded postoperatively. RESULTS: Patient characteristics, operative data, and thromboelastographic tracings were similar among the groups. There were significant decreases in hematocrit level and platelet count and prolongation in prothrombin time postoperatively in all groups without any intergroup differences. The amounts of perioperative blood loss and blood transfusion required were all similar among the groups. CONCLUSION: Preoperative clopidogrel and aspirin exposure even within 2 days of surgery does not increase perioperative blood loss and blood transfusion requirements in patients undergoing elective off-pump coronary artery bypass grafting. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/17599487/Effects_of_preoperative_aspirin_and_clopidogrel_therapy_on_perioperative_blood_loss_and_blood_transfusion_requirements_in_patients_undergoing_off_pump_coronary_artery_bypass_graft_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(07)00545-4 DB - PRIME DP - Unbound Medicine ER -