title: Clopidogrel treatment before coronary artery bypass graft surgery increases postoperative morbidity and blood product requirements.
abstract: OBJECTIVE
  An increasing number of patients are referred for coronary artery bypass graft surgery while treated with clopidogrel. This agent inhibits the platelet P2Y12 adenosine-5'-diphosphate (ADP) receptor, which results in an inhibition of platelet aggregation. The aim of this study was to determine the effect of preoperative clopidogrel treatment on postoperative bleeding, mortality, and morbidity in patients after coronary artery bypass graft surgery.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University hospital (single institution).
  
  
  METHODS
  One hundred forty-four patients who underwent isolated coronary artery bypass graft surgery.
  
  
  METHODS
  Seventy-two patients who received clopidogrel during the preoperative period formed the study group. Seventy-two patients (matched based on age, sex, and preoperative risk profile) served as the control group.
  
  
  RESULTS
  Clopidogrel-treated patients received significantly more platelet (4.4 +/- 5.7 v 1.3 +/- 3.2 U, p < 0.001) and red blood cell (5.1 +/- 4.2 v 2.6 +/- 2.6 U, p < 0.001) transfusions compared with the control group. All-cause mortality and morbidity were significantly higher in clopidogrel-treated patients (n = 7, 9% v n = 1, 1%; p = 0.031). In addition, the lengths of stay in the intensive care unit and the hospital were significantly longer in these patients (2.5 +/- 2.7 v 1.4 +/- 0.9 days, p = 0.002; 9.9 +/- 11 v 6 +/- 2.5 days, p = 0.003). Despite an increased morbidity in the clopidogrel group, the midterm survival was similar between the 2 groups (1-year and 5-year survival 97% +/- 2% and 95.7% +/- 3% v 100% +/- 0% and 87% +/- 10%, respectively; p = 0.885).
  
  
  CONCLUSIONS
  Preoperative clopidogrel is associated with increased transfusion requirement after coronary artery bypass graft surgery. The present data suggest that all-cause mortality and major morbidity may also increase in these patients. In clopidogrel-treated patients, coronary artery bypass graft surgery should be delayed in the absence of specific medical indications as recommended by recent American Heart Association guidelines.
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. Farzan.filsoufi@mountsinai.org
authors.forename: Farzan
authors.initials: F
authors.lastname: Filsoufi
authors.forename: Parwis B
authors.initials: PB
authors.lastname: Rahmanian
authors.forename: Javier G
authors.initials: JG
authors.lastname: Castillo
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Kahn
authors.forename: Gregory
authors.initials: G
authors.lastname: Fischer
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
mesh_terms: D000368:Aged; D001780:Blood Coagulation Tests; D000077144:Clopidogrel; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D017713:Platelet Transfusion / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine