Antiplatelet therapy has been demonstrated to reduce the risk of cardiac events in patients presenting with acute coronary syndrome, yet all effective therapies also increase the risk of bleeding. This study aimed to test the hypothesis that patients undergoing coronary artery bypass grafting, who received clopidogrel within 5 days before surgery, have worse bleeding outcomes and blood transfusion requirements than those who stopped clopidogrel >5 days earlier. We recruited 342 patients who underwent on-pump elective coronary artery bypass grafting between January 2004 and December 2008. Of these, 191 stopped taking clopidogrel >5 days earlier, and 151 stopped ≤5 days before surgery. Postoperative drainage after 8 and 12 h and the total drainage were similar in both groups. There was no significant difference in the amount of blood products used. There was no reexploration in either group. It was concluded that preoperative clopidogrel exposure does not increase the risk of hemostatic reoperation or the requirements for blood and blood product transfusion during and after coronary artery bypass grafting.

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Many simulators today contain traditional opponents and lack an asymmetric insurgent style adversary. InsurgiSim prototypes an embeddable testbed containing a threat network of agents that one can easily configure and deploy for training and analysis purposes. The insurgent network was constructed inside a socio-cognitive agent framework (FactionSim-PMFserv) that includes: (a) a synthesis of best-of-breed models of personality, culture, values, emotions, stress, social relations, mobilization, as well as (b) an IDE for authoring and managing reusable archetypes and their task-sets (Section 2). Agents and markups in this library are not scripted, and act to follow their values and fulfill their needs. So it's desirable to profile the agents (eg, faction leaders, cell logisticians, followers, bomb maker, financier, recruiter, etc.) as faithfully to the real world as possible. Doing this will improve the utility of InsurgiSim for studying what may be driving the insurgent agents in a given area of operation as Section 3 explains. InsurgiSim's bridge is an HLA federate and can be embedded to drive all or some of the insurgent agents in a 3rd party simulator. Three such examples are summarized in Section 4. The paper closes with next steps to improve InsurgiSim's capabilities and utility. Abstract. Many simulators today contain traditional opponents and lack an asymmetric insurgent style adversary. InsurgiSim prototypes an embeddable testbed containing a threat network of agents that one can easily configure and deploy for training and analysis purposes. The insurgent network was constructed inside a socio-cognitive agent framework (FactionSim-PMFserv) that includes: (a) a synthesis of best-of-breed models of personality, culture, values, emotions, stress, social relations, mobilization, as well as (b) an IDE for authoring and managing reusable archetypes and their task-sets (Section 2). Agents and markups in this library are not scripted, and act to follow their values and fulfill their needs. So it's desirable to profile the agents (eg, faction leaders, cell logisticians, followers, bomb maker, financier, recruiter, etc.) as faithfully to the real world as possible. Doing this will improve the utility of InsurgiSim for studying what may be driving the insurgent agents in a given area of operation as Section 3 explains. InsurgiSim's bridge is an HLA federate and can be embedded to drive all or some of the insurgent agents in a 3rd party simulator. Three such examples are summarized in Section 4. The paper closes with next steps to improve InsurgiSim's capabilities and utility.