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Postoperative blood loss in patients undergoing coronary artery bypass surgery after preoperative treatment with clopidogrel. A prospective randomised controlled study.
Eur J Cardiothorac Surg. 2009 Nov; 36(5):856-62.EJ

Abstract

OBJECTIVE

The optimal timing for discontinuation of clopidogrel before surgery remains under debate. The purpose of this study is to determine the effect of preoperative clopidogrel administration on postoperative blood loss and the total requirements of homologous blood products after coronary artery bypass grafting (CABG). We also evaluated the perioperative complications.

METHODS

Consecutive patients (n=130) undergoing elective CABG were recruited and randomised between 2006 and 2007. In 38 patients (group 1), treatment with clopidogrel was discontinued 5 days prior to surgery, in 40 patients (group 2) 3 days before surgery and in 40 other patients (group 3) clopidogrel was stopped on the day of surgery.

RESULTS

Significantly more postoperative blood loss was observed in group 3 compared to group 1 (929+/-472 ml vs 664+/-312 ml; p=0.009). Other group comparisons were not significant. Blood loss after 12 h and at drain removal was also significantly higher in group 3. Patients in group 3 also had higher total requirements of homologous blood products (p=0.046) and a significantly higher need for fresh frozen plasma (FFP) transfusion (p=0.034). Univariable regression analyses revealed that continuing clopidogrel till the day of surgery (group 3) was predictive for postoperative blood loss (beta=0.289; p=0.007) and the total requirements of homologous blood products after surgery (beta=0.280; p=0.008). These effects remained the same in multivariable analyses.

CONCLUSIONS

Continuation of clopidogrel until the day of surgery induces significantly more postoperative blood loss and increases significantly the total requirements of homologous blood products and FFP transfusion after surgery. The blood loss and the use of blood products in the group that stopped at 3 days preoperatively were similar to that of the group that stopped at 5 days preoperatively.

Authors+Show Affiliations

Department of Cardio-thoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands. cristina.firanescu@cze.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19616440

Citation

Firanescu, Cristina E., et al. "Postoperative Blood Loss in Patients Undergoing Coronary Artery Bypass Surgery After Preoperative Treatment With Clopidogrel. a Prospective Randomised Controlled Study." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 36, no. 5, 2009, pp. 856-62.
Firanescu CE, Martens EJ, Schönberger JP, et al. Postoperative blood loss in patients undergoing coronary artery bypass surgery after preoperative treatment with clopidogrel. A prospective randomised controlled study. Eur J Cardiothorac Surg. 2009;36(5):856-62.
Firanescu, C. E., Martens, E. J., Schönberger, J. P., Soliman Hamad, M. A., & van Straten, A. H. (2009). Postoperative blood loss in patients undergoing coronary artery bypass surgery after preoperative treatment with clopidogrel. A prospective randomised controlled study. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 36(5), 856-62. https://doi.org/10.1016/j.ejcts.2009.05.032
Firanescu CE, et al. Postoperative Blood Loss in Patients Undergoing Coronary Artery Bypass Surgery After Preoperative Treatment With Clopidogrel. a Prospective Randomised Controlled Study. Eur J Cardiothorac Surg. 2009;36(5):856-62. PubMed PMID: 19616440.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postoperative blood loss in patients undergoing coronary artery bypass surgery after preoperative treatment with clopidogrel. A prospective randomised controlled study. AU - Firanescu,Cristina E, AU - Martens,Elisabeth J, AU - Schönberger,Jacques P A M, AU - Soliman Hamad,Mohamed A, AU - van Straten,Albert H M, Y1 - 2009/07/17/ PY - 2008/12/04/received PY - 2009/05/01/revised PY - 2009/05/19/accepted PY - 2009/7/21/entrez PY - 2009/7/21/pubmed PY - 2010/5/22/medline SP - 856 EP - 62 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 36 IS - 5 N2 - OBJECTIVE: The optimal timing for discontinuation of clopidogrel before surgery remains under debate. The purpose of this study is to determine the effect of preoperative clopidogrel administration on postoperative blood loss and the total requirements of homologous blood products after coronary artery bypass grafting (CABG). We also evaluated the perioperative complications. METHODS: Consecutive patients (n=130) undergoing elective CABG were recruited and randomised between 2006 and 2007. In 38 patients (group 1), treatment with clopidogrel was discontinued 5 days prior to surgery, in 40 patients (group 2) 3 days before surgery and in 40 other patients (group 3) clopidogrel was stopped on the day of surgery. RESULTS: Significantly more postoperative blood loss was observed in group 3 compared to group 1 (929+/-472 ml vs 664+/-312 ml; p=0.009). Other group comparisons were not significant. Blood loss after 12 h and at drain removal was also significantly higher in group 3. Patients in group 3 also had higher total requirements of homologous blood products (p=0.046) and a significantly higher need for fresh frozen plasma (FFP) transfusion (p=0.034). Univariable regression analyses revealed that continuing clopidogrel till the day of surgery (group 3) was predictive for postoperative blood loss (beta=0.289; p=0.007) and the total requirements of homologous blood products after surgery (beta=0.280; p=0.008). These effects remained the same in multivariable analyses. CONCLUSIONS: Continuation of clopidogrel until the day of surgery induces significantly more postoperative blood loss and increases significantly the total requirements of homologous blood products and FFP transfusion after surgery. The blood loss and the use of blood products in the group that stopped at 3 days preoperatively were similar to that of the group that stopped at 5 days preoperatively. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/19616440/Postoperative_blood_loss_in_patients_undergoing_coronary_artery_bypass_surgery_after_preoperative_treatment_with_clopidogrel__A_prospective_randomised_controlled_study_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2009.05.032 DB - PRIME DP - Unbound Medicine ER -