Tags

Type your tag names separated by a space and hit enter

Impact of clopidogrel in patients with acute coronary syndromes requiring coronary artery bypass surgery: a multicenter analysis.
J Am Coll Cardiol. 2008 Nov 18; 52(21):1693-701.JACC

Abstract

OBJECTIVES

The purpose of our multicenter study was to examine the impact of pre-operative administration of clopidogrel on reoperation rates, incidence of life-threatening bleeding, inpatient length of stay, and other bleeding-related outcomes in acute coronary syndrome (ACS) patients requiring cardiopulmonary bypass (coronary artery bypass graft surgery [CABG]) in a broad cross section of U.S. hospitals.

BACKGROUND

There is relative uncertainty about the relationship between clopidogrel and CABG-associated outcomes in the setting of ACS.

METHODS

A retrospective cohort analysis was performed of randomly selected ACS patients requiring CABG in 14 hospitals across the U.S. Patients exposed to clopidogrel were compared with those not exposed to clopidogrel within 5 days prior to surgery.

RESULTS

Of the 596 patients enrolled in the study, 298 had been exposed to clopidogrel within 5 days (Group A). Patients in Group A were more than 3-fold more likely to require reoperation for assessment of bleeding than patients not exposed to clopidogrel (6.4% vs. 1.7% Group B, p = 0.004). Major bleeding occurred in 35% of Group A patients versus 26% of Group B patients (p = 0.049). Length of stay was greater in Group A compared with Group B (9.7 +/- 6.0 days vs. 8.6 +/- 4.7 days, unadjusted p = 0.016). After logistic regression analysis, clopidogrel exposure within 5 days of CABG was the strongest predictor of reoperation (odds ratio [OR]: 4.60, 95% confidence interval [CI]: 1.45 to 14.55) and major bleeding (OR: 1.824, 95% CI: 1.106 to 3.008).

CONCLUSIONS

After ACS, patients who undergo CABG within 5 days of receiving clopidogrel are at increased risk for reoperation, major bleeding, and increased length of stay. These risks must be balanced by the clinical benefits of clopidogrel use demonstrated in randomized clinical trials.

Authors+Show Affiliations

Division of Cardiology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina 27705, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19007688

Citation

Berger, Jeffrey S., et al. "Impact of Clopidogrel in Patients With Acute Coronary Syndromes Requiring Coronary Artery Bypass Surgery: a Multicenter Analysis." Journal of the American College of Cardiology, vol. 52, no. 21, 2008, pp. 1693-701.
Berger JS, Frye CB, Harshaw Q, et al. Impact of clopidogrel in patients with acute coronary syndromes requiring coronary artery bypass surgery: a multicenter analysis. J Am Coll Cardiol. 2008;52(21):1693-701.
Berger, J. S., Frye, C. B., Harshaw, Q., Edwards, F. H., Steinhubl, S. R., & Becker, R. C. (2008). Impact of clopidogrel in patients with acute coronary syndromes requiring coronary artery bypass surgery: a multicenter analysis. Journal of the American College of Cardiology, 52(21), 1693-701. https://doi.org/10.1016/j.jacc.2008.08.031
Berger JS, et al. Impact of Clopidogrel in Patients With Acute Coronary Syndromes Requiring Coronary Artery Bypass Surgery: a Multicenter Analysis. J Am Coll Cardiol. 2008 Nov 18;52(21):1693-701. PubMed PMID: 19007688.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of clopidogrel in patients with acute coronary syndromes requiring coronary artery bypass surgery: a multicenter analysis. AU - Berger,Jeffrey S, AU - Frye,Carla B, AU - Harshaw,Qing, AU - Edwards,Fred H, AU - Steinhubl,Steven R, AU - Becker,Richard C, PY - 2008/04/03/received PY - 2008/06/27/revised PY - 2008/08/11/accepted PY - 2008/11/15/pubmed PY - 2008/12/17/medline PY - 2008/11/15/entrez SP - 1693 EP - 701 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 52 IS - 21 N2 - OBJECTIVES: The purpose of our multicenter study was to examine the impact of pre-operative administration of clopidogrel on reoperation rates, incidence of life-threatening bleeding, inpatient length of stay, and other bleeding-related outcomes in acute coronary syndrome (ACS) patients requiring cardiopulmonary bypass (coronary artery bypass graft surgery [CABG]) in a broad cross section of U.S. hospitals. BACKGROUND: There is relative uncertainty about the relationship between clopidogrel and CABG-associated outcomes in the setting of ACS. METHODS: A retrospective cohort analysis was performed of randomly selected ACS patients requiring CABG in 14 hospitals across the U.S. Patients exposed to clopidogrel were compared with those not exposed to clopidogrel within 5 days prior to surgery. RESULTS: Of the 596 patients enrolled in the study, 298 had been exposed to clopidogrel within 5 days (Group A). Patients in Group A were more than 3-fold more likely to require reoperation for assessment of bleeding than patients not exposed to clopidogrel (6.4% vs. 1.7% Group B, p = 0.004). Major bleeding occurred in 35% of Group A patients versus 26% of Group B patients (p = 0.049). Length of stay was greater in Group A compared with Group B (9.7 +/- 6.0 days vs. 8.6 +/- 4.7 days, unadjusted p = 0.016). After logistic regression analysis, clopidogrel exposure within 5 days of CABG was the strongest predictor of reoperation (odds ratio [OR]: 4.60, 95% confidence interval [CI]: 1.45 to 14.55) and major bleeding (OR: 1.824, 95% CI: 1.106 to 3.008). CONCLUSIONS: After ACS, patients who undergo CABG within 5 days of receiving clopidogrel are at increased risk for reoperation, major bleeding, and increased length of stay. These risks must be balanced by the clinical benefits of clopidogrel use demonstrated in randomized clinical trials. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/19007688/Impact_of_clopidogrel_in_patients_with_acute_coronary_syndromes_requiring_coronary_artery_bypass_surgery:_a_multicenter_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)02926-4 DB - PRIME DP - Unbound Medicine ER -