title: 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.
abstract: 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.
authors: 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
authors: Alexandre
authors: A
authors: Ouattara
authors: Hassine
authors: H
authors: Bouzguenda
authors: Yannick
authors: Y
authors: Le Manach
authors: Philippe
authors: P
authors: Léger
authors: Anne
authors: A
authors: Mercadier
authors: Pascal
authors: P
authors: Leprince
authors: Nicolas
authors: N
authors: Bonnet
authors: Gilles
authors: G
authors: Montalescot
authors: Bruno
authors: B
authors: Riou
authors: Pierre
authors: P
authors: Coriat
mesh_terms: 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
chemical_list: D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors; D007611:Aprotinin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin