Off-Pump Coronary Artery Bypass Grafting Attenuates Postoperative Bleeding Associated with Preoperative Clopidogrel Administration

Authors

  • Y. Joseph Woo
  • Todd Grand
  • Nicholas Valettas

DOI:

https://doi.org/10.1532/hsf.970

Abstract

Background: Clopidogrel is being increasingly administered as primary therapy for acute coronary syndromes and prior to planned percutaneous coronary intervention (PCI). In these settings, surgical revascularization results in significantly increased postoperative bleeding, transfusion, and reexploration. Off-pump coronary artery bypass grafting (OPCAB) may decrease the extent of postoperative bleeding in patients exposed to clopidogrel.

Methods: The cases of 78 consecutive patients undergoing OPCAB by a single surgeon were retrospectively analyzed, and the patients were divided into 2 groups, those with immediately preoperative clopidogrel exposure (clopidogrel OPCAB, n = 15) and those without (control OPCAB, n = 63). Multiple perioperative parameters were statistically compared. The clopidogrel OPCAB group also was compared with a group of previously described on-pump coronary bypass patients who made up a historical control group (n = 59).

Results: Postoperative bleeding, transfusion requirements, reexploration rates, duration of mechanical ventilation, and length of stay were markedly less for clopidogrel OPCAB patients than for historical controls and were statistically equivalent to those of control OPCAB patients.

Conclusion: Among these 15 OPCAB patients with immediately preoperative administration of clopidogrel and aspirin, outcome was improved compared with published results for on-pump coronary bypass patients and was equivalent to results among OPCAB patients not exposed to clopidogrel. Published, recommended approaches to clopidogrel administration, such as avoidance of pre-PCI clopidogrel, delay of surgery, and platelet transfusion do not appear to be necessary with OPCAB.

References

Criado FJ, Lingelbach JM, Ledesma DF, et al. 2002. Carotid artery stenting in a vascular surgery practice. J Vasc Surg 35:430-4.nCURE Trial Investigators. 2001. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 345:494-502.nGaspoz JM, Coxson PG, Goldman PA, et al. 2002. Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. N Engl J Med 346:1800-6.nHiatt WR. 2002. Pharmacologic therapy for peripheral arterial disease and claudication. J Vasc Surg 36:1283-91.nHongo RH, Ley J, Dick SE. 2002. The effect of clopidogrel in combination with aspirin when given before coronary artery bypass grafting. J Am Coll Cardiol 40:231-7.nIzaguirre-Avila R, De la Pena-Diaz A, Barinagarrementeria-Aldatz F, et al. 2002. Effect of clopidogrel on platelet aggregation and plasma concentration of fibrinogen in subjects with cerebral of coronary atherosclerotic disease. Clin Appl Thromb Hemost 8:169-77.nLevy JH. 2001. Pharmacologic preservation of the hemostatic system during cardiac surgery. Ann Thorac Surg 72:S1814-20.nNader ND, Khadra WZ, Reich NT, et al. 1999. Blood product use in cardiac revascularization: comparison of on- and off-pump techniques. Ann Thorac Surg 68:1640-3.nNikhil JY, Radhakrishnan S, Paradiso-Hardy FL. 2002. Clopidogrel in interventional cardiology: questions answered and questions remaining. Can J Cardiol 18:739-48.nPayne DA, Hayes PD, Jones CI, Belham P, Naylor AR, Goodall AH. 2002. Combined therapy with clopidogrel and aspirin significantly increases the bleeding time through a synergistic antiplatelet action. J Vasc Surg 35:1204-9.nPuskas JD, Thourani VH, Marshall JJ, et al. 2001. Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients. Ann Thorac Surg 71:1477-83.nSavcic M, Hauert J, Bachmann F, et al. 1999. Clopidogrel loading dose regimens: kinetic profile of pharmacodynamic response in healthy subjects. Semin Thromb Hemost 25(suppl)2:15-9.nSteinhubl SR, Berger PB, Mann TJ III, et al. 2002. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 288:2411-20.nYende S, Wunderink RG. 2001. Effect of clopidogrel on bleeding after coronary artery bypass surgery. Crit Care Med 29:2271-5.nBudaj A, Yusuf S, Mehta SR, et al. 2002. Benefit of clopidogrel in patients with acute coronary syndromes without ST-segment elevation in various risk groups. Circulation 106:1622-6.nCasati V, Chiara G, Annalisa F, et al. 2001. Activation of coagulation and fibrinolysis during coronary surgery: on-pump versus off-pump techniques. Anesthesiology 95:1103-9.n

Published

2005-02-08

How to Cite

Woo, Y. J., Grand, T., & Valettas, N. (2005). Off-Pump Coronary Artery Bypass Grafting Attenuates Postoperative Bleeding Associated with Preoperative Clopidogrel Administration. The Heart Surgery Forum, 6(5), 282-285. https://doi.org/10.1532/hsf.970

Issue

Section

Article