| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2004;26:96-101
© 2004 Elsevier Science NL
a Clinic for Cardiovascular Surgery, University Hospital, Berne, Switzerland
b Division of Cardiology, University Hospital, Berne, Switzerland
Received 18 October 2003; received in revised form 15 March 2004; accepted 22 March 2004.
* Corresponding author. Tel.: +41-31-632-2375; fax: +41-31-632-4443
e-mail: thierry.carrel{at}insel.ch
Objective: Clopidogrel has become the standard of care to prevent thrombotic complications following cardiological interventions, in particular intracoronary stenting. In addition, patients with aspirin intolerance and those with carotid and peripheral vascular disease are also increasingly treated with clopidogrel. Platelet inhibition may become a concern for hemostasis in patients treated with clopidogrel who need emergency and undelayed surgery. Methods: We prospectively analyzed the intra- and postoperative outcome of 505 consecutive patients who underwent isolated CABG and compared two groups: those with clopidogrel exposure until 72 h prior to surgery (n=136) with those without exposition to clopidogrel (n=369). Patients undergoing emergency surgery because of failed PTCA and cardiogenic shock, associated valvular surgery, redo-CABG, and those with additional platelet IIb/IIIa receptor inhibitor exposure were excluded. Patients who received aspirin and/or heparin treatment prior to surgery were not excluded. Results: Patients who received clopidogrel had a higher prevalence of angina class III or IV (67 vs 39%, P<0.01), received more often revascularization within 48 h (41 vs 14%, P=0.02), and had received more frequently stenting (57 vs 13%). Chest tube drainage was significantly increased during the first 24 h following CABG in the group of patients who had clopidogrel treatment (1485 vs 780 ml, P=0.003) These patients also required more transfusion of platelets and fresh frozen plasma. Overall re-exploration rate because of bleeding was significantly higher in the clopidogrel group (5.9 vs 1.2%, P<0.01). Platelets transfused before chest closure had a beneficial effect on preservation of the hemostasis. Conclusions: Clopidogrel exposure 3 days or less prior to CABG surgery significantly increases the risk of postoperative bleeding, the need for perioperative transfusion and the incidence of re-exploration. Surgery should be performed using standard heparinization and anti-fibrinolytic strategies but aggressive correction of platelets dysfunction is required before chest closure.
Key Words: Coronary artery bypass grafting • Clopidogrel • Antiplatelet therapy • Blood loss • Transfusion requirements
This article has been cited by other articles:
|
|
 |
|
  S. F. Aranki and S. C. Body Antiplatelet agents used for early intervention in acute coronary syndrome: Myocardial salvage versus bleeding complications. J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 807 - 810.e7. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Ebrahimi, C. Dyke, R. Mehran, S. V. Manoukian, F. Feit, D. A. Cox, B. J. Gersh, E. M. Ohman, H. D. White, J. W. Moses, et al. Outcomes following pre-operative clopidogrel administration in patients with acute coronary syndromes undergoing coronary artery bypass surgery: the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial. J. Am. Coll. Cardiol., May 26, 2009; 53(21): 1965 - 1972. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Smout and G. Stansby Surgery and antiplatelet agents: what are the risks? Clin Risk, May 1, 2009; 15(3): 101 - 105. [Full Text] [PDF]
|
|
|
|
|
|
G. N. Vaccarino, J. Thierer, M. Albertal, M. Vrancic, F. Piccinini, M. Benzadon, H. Raich, and D. O. Navia Impact of preoperative clopidogrel in off pump coronary artery bypass surgery: a propensity score analysis. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 309 - 313. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Dunning, M. Versteegh, A. Fabbri, A. Pavie, P. Kolh, U. Lockowandt, S. A.M. Nashef, and on behalf of the EACTS Audit and Guidelines Commit Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 73 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Becker Emerging constructs to maintain safety among patients with acute coronary syndromes requiring surgical coronary revascularization Eur. Heart J. Suppl., May 1, 2008; 10(suppl_D): D12 - D22. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Andreasen, M. Westen, P. A. Pallesen, S. Jensen, A. Gorst-Rasmussen, and S. P. Johnsen Transfusion practice in coronary artery bypass surgery in Denmark: a multicenter audit Interactive CardioVascular and Thoracic Surgery, October 1, 2007; 6(5): 623 - 627. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Ouattara, H. Bouzguenda, Y. Le Manach, P. Leger, A. Mercadier, P. Leprince, N. Bonnet, G. Montalescot, B. Riou, and P. Coriat Impact of aspirin with or without clopidogrel on postoperative bleeding and blood transfusion in coronary surgical patients treated prophylactically with a low-dose of aprotinin Eur. Heart J., April 12, 2007; (2007) ehm049v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Kunadian, A. R. Thornley, M. Tanos, and J. Dunning Should clopidogrel be stopped prior to urgent cardiac surgery? Interactive CardioVascular and Thoracic Surgery, October 1, 2006; 5(5): 630 - 636. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Mehta, M. T. Roe, J. Mulgund, E. M. Ohman, C. P. Cannon, W. B. Gibler, C. V. Pollack Jr, S. C. Smith Jr, T. B. Ferguson, and E. D. Peterson Acute Clopidogrel Use and Outcomes in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Artery Bypass Surgery J. Am. Coll. Cardiol., July 18, 2006; 48(2): 281 - 286. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. I. Kapetanakis, D. A. Medlam, K. R. Petro, E. Haile, P. C. Hill, M. K.C. Dullum, A. S. Bafi, S. W. Boyce, and P. J. Corso Effect of Clopidogrel Premedication in Off-Pump Cardiac Surgery: Are We Forfeiting the Benefits of Reduced Hemorrhagic Sequelae? Circulation, April 4, 2006; 113(13): 1667 - 1674. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Rigatelli and J. J. Connors III Endovascular Carotid Stenting in Patients Scheduled for Cardiac Surgery: If Yes, Which First? AJNR Am. J. Neuroradiol., January 1, 2006; 27(1): 11 - 12. [Full Text] [PDF]
|
|
|
|
|
|
F. Nurozler, T. Kutlu, G. Kucuk, and C. Okten Impact of clopidogrel on postoperative blood loss after non-elective coronary bypass surgery Interactive CardioVascular and Thoracic Surgery, December 1, 2005; 4(6): 546 - 549. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-Y. Leong, R. A. Baker, P. J. Shah, V. K. Cherian, and J. L. Knight Clopidogrel and Bleeding After Coronary Artery Bypass Graft Surgery Ann. Thorac. Surg., September 1, 2005; 80(3): 928 - 933. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hyllner, E. Houltz, and A. Jeppsson Recombinant activated factor VII in the management of life-threatening bleeding in cardiac surgery Eur. J. Cardiothorac. Surg., August 1, 2005; 28(2): 254 - 258. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A Sobieski II, M. S Slaughter, D. E Hart, P. S Pappas, and A. J Tatooles Prospective study on cardiopulmonary bypass prime reduction and its effect on intraoperative blood product and hemoconcentrator use Perfusion, January 1, 2005; 20(1): 31 - 37. [Abstract] [PDF]
|
|
|
|
|
|
V. Shrivastava and E. Akowuah Impact of clopidogrel in coronary artery bypass grafting Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 176 - 177. [Full Text] [PDF]
|
|
|
|
|
|
L. Englberger and T. Carrel Reply to Shrivastava and Akowuah Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 177 - 177. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
