Platelet-rich intracoronary thrombus is central to the pathogenesis of acute coronary syndrome, and patients scheduled for coronary artery bypass graft (CABG) surgery today are receiving more antiplatelet drugs. The use of such drugs, especially the Clopidogrel, before the surgery creates a major dilemma for cardiac surgeons. Our primary objective was to evaluate the role of Clopidogrel on operative bleeding and the timing of discontinuing the medication before surgery. Secondary objectives were to assess the incidence of blood and platelet transfusions following its use.
We retrospectively analysed 453 patients undergoing off-pump CABG surgery which received or not Clopidogrel in the last 3 years, looking at the mean operative bleeding (per, post and total) and determining risks factors for blood or platelet transfusions using a multivariate analysis.
Clopidogrel in off-pump CABG surgery is associated with higher operative and post-operative bleeding (702 vs 554 cc, p=0.03 and 864 vs 603 cc, p=0.03). Stopping Clopidogrel 72 hours before surgery significantly reduces mean operative blood loss (554 vs 802 cc, p<0.0001). Patients off Clopidogrel for more than 72 hours don’t seem to bleed more than the control group (p=NS). The use of Clopidogrel is associated with more platelet transfusions (OR=11.79, [1.48; 93.86]), but blood transfusions seems similar in all group studied (p=NS).
Mean operative blood loss is higher in patients who used Clopidogrel before surgery. Clopidogrel is associated with more platelet, but not blood transfusions after off-pump CABG surgery. Stopping Clopidogrel 72 hours before surgery shows similar mean operative blood loss compared to control group.
Stopping Clopidogrel 72 hours before surgery shows similar mean operative blood loss compared to control group.
Simon Maltais, None.