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Does Clopidogrel Increase Blood Loss Following Coronary Artery Bypass Surgery?
- Source :
- The Annals of Thoracic Surgery. 78:1536-1541
- Publication Year :
- 2004
- Publisher :
- Elsevier BV, 2004.
-
Abstract
- Clopidogrel (Plavix) is a potent inhibitor of platelet aggregation used concomitantly with percutaneous coronary interventions and in patients with acute coronary syndromes. Its favorable effects on preventing thrombus formation may have deleterious effects on hemostasis in patients undergoing coronary surgery.Data were collected prospectively on 312 consecutive urgent or emergent coronary artery bypass patients from July 1999 through April 2001 at a tertiary care center. Patients were stratified into three groups: clopidogrel within 4 days of operation (n = 41), clopidogrel continued until 5 to 8 days before operation (n = 39), and clopidogrel discontinued more than 8 days before operation or were never taking clopidogrel (n = 232).Preoperative and intraoperative characteristics were similar among all groups. Mediastinal and pericardial chest tube losses in the first 24 hours were 1,044 +/- 750 mL in the clopidogrel within 4 days group, 528 +/- 250 mL in the clopidogrel 5 to 8 days group, and 573 +/- 329 mL in the clopidogrel more than 8 days group (p0.01). The mean total blood product transfusions were 12.2 +/- 15.4 U, 1.2 +/- 2.0 U, and 2.6 +/- 5.7 U, respectively (p0.001). Reoperation for bleeding was noted in 14.6%, 2.6%, and 1.7%, respectively (p = 0.002). The median hospital lengths of stay for the three groups were 9 days, 7 days, and 7 days, respectively (p = 0.018). There were no statistically significant differences in mortality rate, myocardial infarction, stroke, mediastinitis, or postoperative renal failure among the groups. Multivariable analysis revealed that clopidogrel within 0 to 4 days of operation was an independent predictor of transfusion requirements (OR 4.22, 95% confidence interval [CI] 2.07, 9.34, p = 0.001), intensive care unit (ICU) length of stay (OR 3.14, 95% CI 1.40, 7.04, p = 0.006), and total hospital length of stay (coefficient 7.65, se 2.41, p = 0.002).Clopidogrel within 4 days of coronary bypass surgery is associated with increased blood losses and reoperation for bleeding and, according to multivariable models, is an independent risk factor for increased transfusion requirements and prolonged ICU and hospital length of stay.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Ticlopidine
Critical Care
Premedication
Blood Loss, Surgical
Postoperative Hemorrhage
Drug Administration Schedule
law.invention
Coronary artery bypass surgery
Postoperative Complications
Risk Factors
law
Internal medicine
London
medicine
Humans
Blood Transfusion
Prospective Studies
cardiovascular diseases
Myocardial infarction
Coronary Artery Bypass
Thrombus
Stroke
Aged
Aspirin
business.industry
Drug Synergism
Length of Stay
Middle Aged
Platelet Activation
medicine.disease
Clopidogrel
Intensive care unit
Intensive Care Units
Bypass surgery
Hemostasis
Anesthesia
Cardiology
Drug Therapy, Combination
Female
Surgery
Emergencies
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
medicine.drug
Subjects
Details
- ISSN :
- 00034975
- Volume :
- 78
- Database :
- OpenAIRE
- Journal :
- The Annals of Thoracic Surgery
- Accession number :
- edsair.doi.dedup.....238a11efd4329fdd18cb0f66a7047c35