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Effects of a waiting period after clopidogrel treatment before performing coronary artery bypass grafting.
Pharmacotherapy. 2008 Feb; 28(2):151-5.P

Abstract

STUDY OBJECTIVE

To assess the effects of a waiting period after clopidogrel treatment before coronary artery bypass grafting (CABG). Design. Single-center, prospective, observational study.

SETTING

Cardiothoracic surgery intensive care unit at a university-affiliated medical center.

PATIENTS

One hundred consecutive patients who received clopidogrel and were scheduled to undergo primary CABG. In 64 of these patients, CABG was delayed at least 5 days after clopidogrel treatment (group A). The other 36 patients received clopidogrel treatment within 5 days of undergoing CABG (group B).

MEASUREMENTS AND MAIN RESULTS

Data were collected on patient demographics, time of last clopidogrel dose, preoperative anticoagulant and/or antiplatelet agents administered, surgical characteristics, intraoperative transfusions, blood products transfused, and chest tube output for 24 hours after surgery. No significant differences in baseline characteristics or intraoperative variables (number of bypasses, aortic cross-clamp time, and cardiopulmonary bypass time) were noted between the two groups. Mean +/- SD number of packed red blood cell units/patient was 1.1 +/- 1.4 in group A versus 2.1 +/- 2.5 in group B (p=0.009). Mean +/- SD number of platelet units/patient transfused was 0.5 +/- 0.9 in group A versus 1.9 +/- 1.6 in group B (p<0.001). When comparing a subset of 21 patients who received clopidogrel within 72 hours of surgery with the 64 whose CABG was delayed at least 5 days after clopidogrel treatment, the transfusion rates were significantly higher (95% vs 52%, p<0.05). Specifically, the mean +/- SD number of transfused units/patient of red blood cells (3.1 +/- 2.8 vs 1.1 +/- 1.4, p<0.005) and platelets (2.6 +/- 1.5 vs 0.5 +/- 0.9, p<0.007) was greater in patients who received clopidogrel within 72 hours of surgery.

CONCLUSION

A strategy to delay CABG after clopidogrel treatment led to reduced blood product administration. The optimal waiting period after clopidogrel treatment is not known but appears to be at least 5 days before CABG.

Authors+Show Affiliations

Department of Pharmacy, Wake Forest University Baptist Medical Center, School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA. mreicher@wfubmc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18225962

Citation

Reichert, Marc G., et al. "Effects of a Waiting Period After Clopidogrel Treatment Before Performing Coronary Artery Bypass Grafting." Pharmacotherapy, vol. 28, no. 2, 2008, pp. 151-5.
Reichert MG, Robinson AH, Travis JA, et al. Effects of a waiting period after clopidogrel treatment before performing coronary artery bypass grafting. Pharmacotherapy. 2008;28(2):151-5.
Reichert, M. G., Robinson, A. H., Travis, J. A., Hammon, J. W., Kon, N. D., & Kincaid, E. H. (2008). Effects of a waiting period after clopidogrel treatment before performing coronary artery bypass grafting. Pharmacotherapy, 28(2), 151-5. https://doi.org/10.1592/phco.28.2.151
Reichert MG, et al. Effects of a Waiting Period After Clopidogrel Treatment Before Performing Coronary Artery Bypass Grafting. Pharmacotherapy. 2008;28(2):151-5. PubMed PMID: 18225962.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of a waiting period after clopidogrel treatment before performing coronary artery bypass grafting. AU - Reichert,Marc G, AU - Robinson,Amanda H, AU - Travis,Jeffrey A, AU - Hammon,John W, AU - Kon,Neal D, AU - Kincaid,Edward H, PY - 2008/1/30/pubmed PY - 2008/3/28/medline PY - 2008/1/30/entrez SP - 151 EP - 5 JF - Pharmacotherapy JO - Pharmacotherapy VL - 28 IS - 2 N2 - STUDY OBJECTIVE: To assess the effects of a waiting period after clopidogrel treatment before coronary artery bypass grafting (CABG). Design. Single-center, prospective, observational study. SETTING: Cardiothoracic surgery intensive care unit at a university-affiliated medical center. PATIENTS: One hundred consecutive patients who received clopidogrel and were scheduled to undergo primary CABG. In 64 of these patients, CABG was delayed at least 5 days after clopidogrel treatment (group A). The other 36 patients received clopidogrel treatment within 5 days of undergoing CABG (group B). MEASUREMENTS AND MAIN RESULTS: Data were collected on patient demographics, time of last clopidogrel dose, preoperative anticoagulant and/or antiplatelet agents administered, surgical characteristics, intraoperative transfusions, blood products transfused, and chest tube output for 24 hours after surgery. No significant differences in baseline characteristics or intraoperative variables (number of bypasses, aortic cross-clamp time, and cardiopulmonary bypass time) were noted between the two groups. Mean +/- SD number of packed red blood cell units/patient was 1.1 +/- 1.4 in group A versus 2.1 +/- 2.5 in group B (p=0.009). Mean +/- SD number of platelet units/patient transfused was 0.5 +/- 0.9 in group A versus 1.9 +/- 1.6 in group B (p<0.001). When comparing a subset of 21 patients who received clopidogrel within 72 hours of surgery with the 64 whose CABG was delayed at least 5 days after clopidogrel treatment, the transfusion rates were significantly higher (95% vs 52%, p<0.05). Specifically, the mean +/- SD number of transfused units/patient of red blood cells (3.1 +/- 2.8 vs 1.1 +/- 1.4, p<0.005) and platelets (2.6 +/- 1.5 vs 0.5 +/- 0.9, p<0.007) was greater in patients who received clopidogrel within 72 hours of surgery. CONCLUSION: A strategy to delay CABG after clopidogrel treatment led to reduced blood product administration. The optimal waiting period after clopidogrel treatment is not known but appears to be at least 5 days before CABG. SN - 0277-0008 UR - https://www.unboundmedicine.com/medline/citation/18225962/Effects_of_a_waiting_period_after_clopidogrel_treatment_before_performing_coronary_artery_bypass_grafting_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=18225962.ui DB - PRIME DP - Unbound Medicine ER -