Early administration of clopidogrel is safe after off-pump coronary artery bypass surgery.
BACKGROUND
Patients who undergo off-pump coronary artery bypass graft surgery (OPCAB) may be hypercoagulable with an increased risk of graft thrombosis due to the lack of platelet dysfunction that accompanies "on-pump" surgery. Clopidogrel may be indicated in these patients to prevent recurrent ischemic events. The purpose of this observational study was to determine the safety of early clopidogrel administration after OPCAB.


METHODS
Thirty-day follow-up of 364 consecutive OPCAB patients (January to June, 2002) was determined from a computerized database. One hundred ninety-three patients received clopidogrel 4 hours postoperatively if chest tube output was less than 100 cc/h for 4 hours, then daily for 4 weeks. Aspirin was administered preoperatively and postoperatively to all patients. Telephone follow-up was made 6 to 12 months after OPCAB.


RESULTS
None of the patients who received clopidogrel in the early postoperative period required reoperation for mediastinal hemorrhage. Mean chest tube drainage at 24 hours was 1,024 +/- 563 mL in patients who received clopidogrel and 942 +/- 501 mL in patients who did not receive clopidogrel. The total number of blood units transfused and the number of patients receiving blood transfusions were similar between groups. In-hospital mortality was 1.6% in patients who received clopidogrel and 3.5% in patients who did not receive clopidogrel. No group differences in mortality or adverse cardiac events were observed at 6 months. Gastrointestinal bleeding occurred in 2.2% clopidogrel patients versus 0.7% of patients who did not receive clopidogrel.


CONCLUSIONS
When administered according to our postoperative protocol, OPCAB patients can safely receive clopidogrel in the early postoperative period without increased risk for mediastinal hemorrhage.
Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory Crawford Long Hospitals, Emory University School of Medicine, Atlanta, Georgia, USA.
Michael E
ME
Halkos
William A
WA
Cooper
Rebecca
R
Petersen
John D
JD
Puskas
Omar M
OM
Lattouf
Joseph M
JM
Craver
Robert A
RA
Guyton
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000077144:Clopidogrel; D047549:Coronary Artery Bypass, Off-Pump; D003422:Critical Care; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011184:Postoperative Period; D012086:Reoperation; D012189:Retrospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine