Bleeding Outcomes Associated with Coronary Artery Bypass Graft Surgery and Recent Clopidogrel Exposure

Title

Bleeding Outcomes Associated with Coronary Artery Bypass Graft Surgery and Recent Clopidogrel Exposure

Creator

Blais D M; Zukkoor S M; Hayes C; Pickworth K K; Porter K; Firstenberg M S

Publisher

Heart Surgery Forum

Date

2013
2013-04

Description

Background: Guidelines recommend discontinuing clopidogrel for at least 5 days before elective coronary artery bypass graft surgery (CABG) to limit blood transfusions and for at least 24 hours before urgent CABG to reduce major bleeding complications. Studies have produced conflicting results regarding whether recent exposure to clopidogrel increases bleeding, the need for intraoperative and postoperative blood products, postoperative complications, and hospital length of stay. We evaluated the effect of clopidogrel exposure on major bleeding at our institution within 5 days of CABG. Methods: We conducted a retrospective review of patients who underwent CABG at a tertiary academic medical center. The primary outcome was major bleeding, defined as transfusion of 4 units of packed red blood cells (PRBCs) and/or a need for reexploration. Secondary outcomes included non-life-threatening bleeding, defined as transfusion of 2 units but <4 units of PRBCs; postoperative complications; hospital length of stay; readmission within 30 days of the procedure; and hospital mortality. Major bleeding events were analyzed with a logistic regression model that adjusted for covariates of bleeding risk factors. Results: Of the 715 patients we reviewed, 169 patients received clopidogrel within 5 days before CABG, and 546 patients did not. A significantly higher incidence of major bleeding was observed in the clopidogrel group compared with the group not exposed to clopidogrel (32% versus 17%, P = .002). After adjusting for covariates, patients exposed to clopidogrel had significantly higher odds of major bleeding (odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P = .003). The groups were similar with respect to postoperative complications, except for infection. The clopidogrel-exposed group had a significantly higher rate of leg site infections (3% versus 0.2%, P = .003). Conclusions: Clopidogrel exposure within 5 days of CABG is associated with an increased risk of major bleeding.

Subject

intervention; Surgery; guidelines; Cardiovascular System & Cardiology; Myocardial infarction; controlled-trial; risk; increases; blood-transfusion; aspirin; cardiac-surgery; st-segment elevation

Format

Journal Article or Conference Abstract Publication

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Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

E70-E77

Issue

2

Volume

16

Citation

Blais D M; Zukkoor S M; Hayes C; Pickworth K K; Porter K; Firstenberg M S, “Bleeding Outcomes Associated with Coronary Artery Bypass Graft Surgery and Recent Clopidogrel Exposure,” NEOMED Bibliography Database, accessed July 24, 2021, https://neomed.omeka.net/items/show/8641.

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