Does preoperative clopidogrel increase bleeding after coronary bypass surgery?

Abstract

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.

Excessive bleeding predictors after cardiac surgery in adults: integrative review

“…Nevertheless, Dasarathan et al . () found no differences in the amount of postoperative bleeding between patients who discontinued clopidogrel more than five days before or within five days of first‐time elective CABG with CPB. Different degrees of efficacy due to different brands of the same drug might have accounted for these conflicting results, as well as distinct haemostatic techniques (Firanescu et al .…”

Expert position paper on the management of antiplatelet therapy in patients undergoing coronary artery bypass graft surgery

“…38,39 Shorter windows of clopidogrel interruption have been suggested but time delay alone does not solely account for the difference in the observed magnitude of clopidogrel effect on bleeding. Differences in patient response to P2Y 12 inhibitors, outcome definitions, transfusion triggers, use of antifibrinolytics, and surgeon-related factors may have been sources of bias.…”

The Impact of Preoperative Clopidogrel on Outcomes After Coronary Artery Bypass Grafting

“…[4][5][6] In addition, some studies have demonstrated diminishing risks of reoperation for bleeding in patients exposed to preoperative clopidogrel with improvements in surgical technique and management. 7,8 Given the conflicting data regarding the overall impact of clopidogrel on transfusion and reoperation risk, as well as a lack of standardized and agreed upon guidelines regarding discontinuation before CABG, a current appraisal of this clinical question is prudent. This study evaluated the effect of preoperative clopidogrel administration on outcomes of CABG.…”