title: Thromboresistant surfaces with low-dose anticoagulation alleviate clopidogrel-related complications in patients undergoing coronary artery bypass grafting.
abstract: OBJECTIVE
  Numerous studies have shown that, when using conventional perfusion methodology, patients undergoing coronary artery bypass grafting within 7 days of receiving clopidogrel are at increased risk of bleeding, re-exploration, and blood transfusion. The purpose of this study was to evaluate the effect of clopidogrel administration before coronary artery bypass grafting on patients using thromboresistant surfaces with low-dose heparin during surgical intervention.
  
  
  METHODS
  Patients who underwent isolated coronary artery bypass grafting between 2005 and 2009 were incorporated in this retrospective study. Of these, 52 (22.2%) received clopidogrel within 5 days before the operation, and 182 (77.8%) did not. Regression models determined the effect of clopidogrel on the rate of chest re-exploration because of bleeding, 24-hour chest tube output, perioperative blood product transfusion, length of stay, morbidity, and perioperative mortality. Hemorrhage-related preoperative risk factors, as well as those found to be significant in univariate models, were included in the multivariate model.
  
  
  RESULTS
  Chest tube drainage was significantly increased during the first 24 hours after the operation in the clopidogrel group (679.7 ± 305.8 vs 516.6 ± 209.8 mL, P = .0007). The need for intraoperative blood product transfusion was similar; nevertheless, more patients receiving clopidogrel required fresh frozen plasma postoperatively (7.7% vs 1.1%, P = .0232). However, risk-adjusted logistic regression showed that exposure to clopidogrel was not a predictor of intraoperative or postoperative blood product transfusion. Lengths of stay in the intensive care unit and hospital were shorter in patients receiving clopidogrel.
  
  
  CONCLUSIONS
  Hemostatic complications related to clopidogrel exposure within 5 days before an isolated coronary artery bypass grafting operation can be alleviated by the application of a biocompatible perfusion strategy using low-dose heparin in conjunction with a closed thromboresistant circuit.
authors.affiliation: Department of Cardiothoracic Surgery, VA Boston Healthcare System, Boston, Mass, USA.
authors.forename: Bader E
authors.initials: BE
authors.lastname: Hussaini
authors.forename: Hemant S
authors.initials: HS
authors.lastname: Thatte
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Rhodes
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Treanor
authors.forename: Vladimir
authors.initials: V
authors.lastname: Birjiniuk
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001672:Biocompatible Materials; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001900:Boston; D015505:Chest Tubes; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000295:instrumentation*; D004322:Drainage / Q000295:instrumentation; D004334:Drug Administration Schedule; D004867:Equipment Design; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D001672:Biocompatible Materials; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine