Impact of preoperative clopidogrel in off pump coronary artery bypass surgery: a propensity score analysis.
OBJECTIVE
The aim of our study was to evaluate the impact of recent clopidrogel use before off-pump coronary artery bypass grafting on the postoperative risk of bleeding.


METHODS
During the period January 2003 to December 2006, 1104 consecutive patients underwent off-pump coronary artery bypass grafting. Patients were divided into two groups according to the recent use of clopidrogel (within 7 days). We performed a propensity score to further adjust for differences between the patients with and without recent use of clopidrogel.


RESULTS
Mean age was 64 +/- 14 years and 87% were male. The clopidrogel group had a greater incidence of patients in unstable condition, requiring emergency coronary bypass grafting, and with a high EuroSCORE. Propensity score analysis selected 88 patients with and 176 without recent use of clopidrogel. By propensity score, the clopidrogel group had higher requirements for fresh frozen plasma units (18.1% vs 8.5%; P = .02), reoperation owing to bleeding (5.6% vs 0.5%; P = .009), and higher need for postoperative mechanical ventilation (4% vs 10%; P = .04), whereas mortality and length of stay were similar between groups.


CONCLUSIONS
Recent use of clopidogrel before off-pump coronary artery bypass grafting is associated with greater risk for bleeding with similar mortality rate.
Vaccarino
Guillermo N
GN
Department of Cardiac Surgery, Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
Thierer
Jorge
J
Albertal
Mariano
M
Vrancic
Mariano
M
Piccinini
Fernando
F
Benzadón
Mariano
M
Raich
Hernán
H
Navia
Daniel O
DO
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data*; D000077144:Clopidogrel; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011300:Preoperative Care; D012086:Reoperation / Q000706:statistics & numerical data; D012121:Respiration, Artificial; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine