Effects of a waiting period after clopidogrel treatment before performing coronary artery bypass grafting.
OBJECTIVE
To assess the effects of a waiting period after clopidogrel treatment before coronary artery bypass grafting (CABG). Design. Single-center, prospective, observational study.


METHODS
Cardiothoracic surgery intensive care unit at a university-affiliated medical center.


METHODS
One hundred consecutive patients who received clopidogrel and were scheduled to undergo primary CABG. In 64 of these patients, CABG was delayed at least 5 days after clopidogrel treatment (group A). The other 36 patients received clopidogrel treatment within 5 days of undergoing CABG (group B).


RESULTS
Data were collected on patient demographics, time of last clopidogrel dose, preoperative anticoagulant and/or antiplatelet agents administered, surgical characteristics, intraoperative transfusions, blood products transfused, and chest tube output for 24 hours after surgery. No significant differences in baseline characteristics or intraoperative variables (number of bypasses, aortic cross-clamp time, and cardiopulmonary bypass time) were noted between the two groups. Mean +/- SD number of packed red blood cell units/patient was 1.1 +/- 1.4 in group A versus 2.1 +/- 2.5 in group B (p=0.009). Mean +/- SD number of platelet units/patient transfused was 0.5 +/- 0.9 in group A versus 1.9 +/- 1.6 in group B (p<0.001). When comparing a subset of 21 patients who received clopidogrel within 72 hours of surgery with the 64 whose CABG was delayed at least 5 days after clopidogrel treatment, the transfusion rates were significantly higher (95% vs 52%, p<0.05). Specifically, the mean +/- SD number of transfused units/patient of red blood cells (3.1 +/- 2.8 vs 1.1 +/- 1.4, p<0.005) and platelets (2.6 +/- 1.5 vs 0.5 +/- 0.9, p<0.007) was greater in patients who received clopidogrel within 72 hours of surgery.


CONCLUSIONS
A strategy to delay CABG after clopidogrel treatment led to reduced blood product administration. The optimal waiting period after clopidogrel treatment is not known but appears to be at least 5 days before CABG.
Reichert
Marc G
MG
Department of Pharmacy, Wake Forest University Baptist Medical Center, School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA. mreicher@wfubmc.edu
Robinson
Amanda H
AH
Travis
Jeffrey A
JA
Hammon
John W
JW
Kon
Neal D
ND
Kincaid
Edward H
EH
D000046:Academic Medical Centers; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001810:Blood Volume; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D004334:Drug Administration Schedule; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D017713:Platelet Transfusion / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011292:Premedication; D011300:Preoperative Care; D011446:Prospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine