title: Impact of clopidogrel use on mortality and major bleeding in patients undergoing coronary artery bypass surgery.
abstract: Patients who received clopidogrel prior to coronary bypass surgery are at increased risk for bleeding that must be balanced with risk of ongoing ischemia if coronary artery bypass grafting is delayed. This study aimed to evaluate the impact of clopidogrel on mortality and major bleeding in patients undergoing urgent coronary bypass surgery. We reviewed 451 consecutive patients who underwent urgent isolated coronary bypass surgery; 262 had not received clopidogrel, whereas 189 received clopidogrel < or = 5 days preoperative. The primary endpoint was in-hospital death, massive transfusion or massive blood loss. Patient characteristics were almost similar between groups. There was no difference in in-hospital death or massive bleeding indices between groups (clopidogrel: 7% vs. no clopidogrel: 6%, P = 0.9). No difference was observed even after adjusting for the date of stopping clopidogrel preoperatively. Multivariate regression analysis showed that clopidogrel or the duration it was stopped preoperatively, did not predict adverse outcomes. Significant independent predictors included preoperative renal dysfunction, hemoglobin level and peripheral vascular disease. clopidogrel, or the time it was stopped prior to surgery, was not a risk factor for in-hospital death, massive bleeding, or other poor early outcomes in patients undergoing urgent coronary artery bypass surgery.
authors.affiliation: Division of Cardiac and Vascular Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. nesher61@gmail.com
authors.forename: Nahum
authors.initials: N
authors.lastname: Nesher
authors.forename: Steve K
authors.initials: SK
authors.lastname: Singh
authors.forename: Hosam F
authors.initials: HF
authors.lastname: Fawzy
authors.forename: Jeri Y
authors.initials: JY
authors.lastname: Sever
authors.forename: Bernard E
authors.initials: BE
authors.lastname: Goldman
authors.forename: Gideon N
authors.initials: GN
authors.lastname: Cohen
authors.forename: Claude
authors.initials: C
authors.lastname: Laflamme
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Fremes
mesh_terms: D000704:Analysis of Variance; D000077144:Clopidogrel; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000139:chemically induced / Q000401:mortality / Q000503:physiopathology; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000401:mortality* / Q000503:physiopathology; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000077144:Clopidogrel; D013988:Ticlopidine