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Clopidogrel use and bleeding after coronary artery bypass graft surgery.
Am Heart J. 2008 Nov; 156(5):886-92.AH

Abstract

BACKGROUND

Short-term use of clopidogrel plus aspirin among patients with acute coronary syndrome reduces ischemic events, but concerns about coronary artery bypass graft (CABG) surgery-related bleeding limit its early use.

METHODS

Using data from 4,794 consecutive CABG procedures in the Duke Databank for Cardiovascular Disease (January 1999 to December 2003), we developed multivariable models for associations with CABG-related bleeding defined as reoperation for bleeding, red cell transfusion, and a composite of reoperation/transfusion/hematocrit drop>or=15%. We examined clopidogrel use<or=5 days versus no clopidogrel<or=5 days before CABG in each model. Models were adjusted for propensity for clopidogrel use<or=5 days.

RESULTS

Of 4,794 CABG patients, 332 (6.9%) received clopidogrel<or=5 days before CABG, 127 (2.6%) had reoperation for bleeding, 3,277 (68.4%) received red cell transfusion, and 4,387 (91.5%) had the composite outcome. After adjustment, clopidogrel use<or=5 days was not significantly associated with reoperation (odds ratio [OR] 1.24, 95% CI 0.63-2.41) or the composite end point (OR 1.23, 95% CI 0.72-2.10). Clopidogrel<or=5 days was modestly associated with red cell transfusion (OR 1.40, 95% CI 1.04-1.89) but more weakly than other factors, including which surgeon performed the procedure.

CONCLUSION

Clopidogrel administration<or=5 days before CABG was not significantly associated with reoperation for bleeding or a bleeding composite, and only weakly with red cell transfusion after surgery. The impact of withholding clopidogrel acutely in those for whom clopidogrel has proven benefits and the impact of delaying CABG to prevent bleeding among patients treated with clopidogrel should be viewed in the context of other stronger determinants of bleeding.

Authors+Show Affiliations

Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA.No 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 availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

19061702

Citation

Kim, John Hyung-Jun, et al. "Clopidogrel Use and Bleeding After Coronary Artery Bypass Graft Surgery." American Heart Journal, vol. 156, no. 5, 2008, pp. 886-92.
Kim JH, Newby LK, Clare RM, et al. Clopidogrel use and bleeding after coronary artery bypass graft surgery. Am Heart J. 2008;156(5):886-92.
Kim, J. H., Newby, L. K., Clare, R. M., Shaw, L. K., Lodge, A. J., Smith, P. K., Jolicoeur, E. M., Rao, S. V., Becker, R. C., Mark, D. B., & Granger, C. B. (2008). Clopidogrel use and bleeding after coronary artery bypass graft surgery. American Heart Journal, 156(5), 886-92. https://doi.org/10.1016/j.ahj.2008.06.034
Kim JH, et al. Clopidogrel Use and Bleeding After Coronary Artery Bypass Graft Surgery. Am Heart J. 2008;156(5):886-92. PubMed PMID: 19061702.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clopidogrel use and bleeding after coronary artery bypass graft surgery. AU - Kim,John Hyung-Jun, AU - Newby,L Kristin, AU - Clare,Robert M, AU - Shaw,Linda K, AU - Lodge,Andrew J, AU - Smith,Peter K, AU - Jolicoeur,E Marc, AU - Rao,Sunil V, AU - Becker,Richard C, AU - Mark,Daniel B, AU - Granger,Christopher B, Y1 - 2008/09/21/ PY - 2008/03/28/received PY - 2008/06/28/accepted PY - 2008/12/9/pubmed PY - 2009/1/23/medline PY - 2008/12/9/entrez SP - 886 EP - 92 JF - American heart journal JO - Am Heart J VL - 156 IS - 5 N2 - BACKGROUND: Short-term use of clopidogrel plus aspirin among patients with acute coronary syndrome reduces ischemic events, but concerns about coronary artery bypass graft (CABG) surgery-related bleeding limit its early use. METHODS: Using data from 4,794 consecutive CABG procedures in the Duke Databank for Cardiovascular Disease (January 1999 to December 2003), we developed multivariable models for associations with CABG-related bleeding defined as reoperation for bleeding, red cell transfusion, and a composite of reoperation/transfusion/hematocrit drop>or=15%. We examined clopidogrel use<or=5 days versus no clopidogrel<or=5 days before CABG in each model. Models were adjusted for propensity for clopidogrel use<or=5 days. RESULTS: Of 4,794 CABG patients, 332 (6.9%) received clopidogrel<or=5 days before CABG, 127 (2.6%) had reoperation for bleeding, 3,277 (68.4%) received red cell transfusion, and 4,387 (91.5%) had the composite outcome. After adjustment, clopidogrel use<or=5 days was not significantly associated with reoperation (odds ratio [OR] 1.24, 95% CI 0.63-2.41) or the composite end point (OR 1.23, 95% CI 0.72-2.10). Clopidogrel<or=5 days was modestly associated with red cell transfusion (OR 1.40, 95% CI 1.04-1.89) but more weakly than other factors, including which surgeon performed the procedure. CONCLUSION: Clopidogrel administration<or=5 days before CABG was not significantly associated with reoperation for bleeding or a bleeding composite, and only weakly with red cell transfusion after surgery. The impact of withholding clopidogrel acutely in those for whom clopidogrel has proven benefits and the impact of delaying CABG to prevent bleeding among patients treated with clopidogrel should be viewed in the context of other stronger determinants of bleeding. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19061702/Clopidogrel_use_and_bleeding_after_coronary_artery_bypass_graft_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(08)00556-5 DB - PRIME DP - Unbound Medicine ER -