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Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery.
Ann Thorac Surg. 2010 Feb; 89(2):397-402.AT

Abstract

BACKGROUND

Utilization of the irreversible antiplatelet agent clopidogrel is increasing in the treatment acute coronary syndrome patients. Consequently, more patients are presenting for urgent cardiac surgery with an irreversible defect in platelet function. The objective of this study was to determine whether recent clopidogrel administration predicts transfusion and hemorrhagic complication in cardiac surgery patients.

METHODS

This retrospective study included all patients undergoing isolated coronary artery bypass graft surgery (CABG), isolated valve, or CABG plus valve at a single center between 2004 and 2008. The outcomes of interest were transfusion and hemorrhagic complication. Clopidogrel stop interval was defined as the time between last dose and presentation to the operating room, and was examined in daily increments from 0 to 5 days, more than 5 days, and not receiving clopidogrel preoperatively. By logistic regression, the association of clopidogrel stop interval with transfusion and with hemorrhagic complication was examined after adjusting for other risk factors.

RESULTS

Of 3,779 patients included in this study, 26.4% (999) received clopidogrel preoperatively. The overall rates of transfusion and hemorrhagic complication were 34.1% and 4.1%, respectively. Clopidogrel use within 24 hours was an independent predictor of transfusion (odds ratio 2.4; 95% confidence interval: 1.8 to 3.3) and of hemorrhagic complication (odds ratio 2.1; 95% confidence interval: 1.3 to 3.6).

CONCLUSIONS

Patients receiving clopidogrel within 24 hours of surgery are at increased risk for transfusion and hemorrhagic complication. Timing of surgery for patients receiving clopidogrel should take into account the interval from the last dose.

Authors+Show Affiliations

Division of Cardiac Surgery, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.No 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

20103308

Citation

Herman, Christine R., et al. "Clopidogrel Increases Blood Transfusion and Hemorrhagic Complications in Patients Undergoing Cardiac Surgery." The Annals of Thoracic Surgery, vol. 89, no. 2, 2010, pp. 397-402.
Herman CR, Buth KJ, Kent BA, et al. Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery. Ann Thorac Surg. 2010;89(2):397-402.
Herman, C. R., Buth, K. J., Kent, B. A., & Hirsch, G. M. (2010). Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery. The Annals of Thoracic Surgery, 89(2), 397-402. https://doi.org/10.1016/j.athoracsur.2009.10.051
Herman CR, et al. Clopidogrel Increases Blood Transfusion and Hemorrhagic Complications in Patients Undergoing Cardiac Surgery. Ann Thorac Surg. 2010;89(2):397-402. PubMed PMID: 20103308.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery. AU - Herman,Christine R, AU - Buth,Karen J, AU - Kent,Blaine A, AU - Hirsch,Gregory M, PY - 2009/07/13/received PY - 2009/10/17/revised PY - 2009/10/21/accepted PY - 2010/1/28/entrez PY - 2010/1/28/pubmed PY - 2010/2/18/medline SP - 397 EP - 402 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 89 IS - 2 N2 - BACKGROUND: Utilization of the irreversible antiplatelet agent clopidogrel is increasing in the treatment acute coronary syndrome patients. Consequently, more patients are presenting for urgent cardiac surgery with an irreversible defect in platelet function. The objective of this study was to determine whether recent clopidogrel administration predicts transfusion and hemorrhagic complication in cardiac surgery patients. METHODS: This retrospective study included all patients undergoing isolated coronary artery bypass graft surgery (CABG), isolated valve, or CABG plus valve at a single center between 2004 and 2008. The outcomes of interest were transfusion and hemorrhagic complication. Clopidogrel stop interval was defined as the time between last dose and presentation to the operating room, and was examined in daily increments from 0 to 5 days, more than 5 days, and not receiving clopidogrel preoperatively. By logistic regression, the association of clopidogrel stop interval with transfusion and with hemorrhagic complication was examined after adjusting for other risk factors. RESULTS: Of 3,779 patients included in this study, 26.4% (999) received clopidogrel preoperatively. The overall rates of transfusion and hemorrhagic complication were 34.1% and 4.1%, respectively. Clopidogrel use within 24 hours was an independent predictor of transfusion (odds ratio 2.4; 95% confidence interval: 1.8 to 3.3) and of hemorrhagic complication (odds ratio 2.1; 95% confidence interval: 1.3 to 3.6). CONCLUSIONS: Patients receiving clopidogrel within 24 hours of surgery are at increased risk for transfusion and hemorrhagic complication. Timing of surgery for patients receiving clopidogrel should take into account the interval from the last dose. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/20103308/Clopidogrel_increases_blood_transfusion_and_hemorrhagic_complications_in_patients_undergoing_cardiac_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(09)02162-6 DB - PRIME DP - Unbound Medicine ER -