Impact of aspirin with or without clopidogrel on postoperative bleeding and blood transfusion in coronary surgical patients treated prophylactically with a low-dose of aprotinin.
OBJECTIVE
Aspirin combined with clopidogrel is the treatment of choice for acute coronary syndromes. Although the maintenance of aspirin until surgery does not affect postoperative bleeding after coronary artery bypass graft (CABG) surgery, the latter may be dramatically increased when clopidogrel is continued over a period of 5 days preoperatively.


RESULTS
This prospective observational study included 217 consecutive patients scheduled for first-time CABG. Postoperative bleeding and blood transfusion requirements were compared (equivalence) between patients pretreated during a period of 5 days prior surgery by either aspirin alone (n = 157) or combined with clopidogrel (n = 60). Aprotinin was systematically used in all these patients considered as high risk for bleeding. We found no significant difference between both groups concerning the preoperative characteristics except for unstable angina (33 vs. 19%, P = 0.02) and left main coronary artery stenosis (27 vs. 13%, P = 0.02), which were more frequent in patients receiving clopidogrel. The median chest tube output was similar in both groups 24 h postoperatively at 350 mL (95% CI 150-850) vs. 375 mL (95% CI 175-875), and the difference between groups (7%, 95% CI -9 to 22) did not encompass the predetermined margins of equivalence (25%). No significant difference was found on blood transfusion use (38 vs. 38%, P = 0.99). After adjustment by a propensity score, we found that clopidogrel was not associated with an increased risk of excessive bleeding.


CONCLUSIONS
In patients undergoing first-time CABG and treated prophylactically with aprotinin, aspirin and clopidogrel may be continued until surgery without increasing postoperative bleeding or transfusion requirements.
Ouattara
Alexandre
A
Department of Anaesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris, Paris, France. alexandre.ouattara@psl.aphp.fr
Bouzguenda
Hassine
H
Le Manach
Yannick
Y
Léger
Philippe
P
Mercadier
Anne
A
Leprince
Pascal
P
Bonnet
Nicolas
N
Montalescot
Gilles
G
Riou
Bruno
B
Coriat
Pierre
P
D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D004359:Drug Therapy, Combination; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors; D007611:Aprotinin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin