title: Similar observed CABG related bleeding complications in patients with and without clopidogrel loading doses.
abstract: OBJECTIVE
  Pretreatment with clopidogrel before percutaneous coronary intervention improves cardiovascular outcomes. However, some patients require elective coronary artery bypass graft (CABG) surgery instead, possibly increasing bleeding complications. We sought to assess the hemorrhagic complications and the length of hospital stay of stable patients receiving clopidogrel pretreatment that are referred for CABG.
  
  
  METHODS
  Between March and August 2007, 493 patients underwent diagnostic catheterization; 54 patients underwent elective CABG and were stratified according to clopidogrel loading dose (n = 20) or not (n = 34). Incidences of major hemorrhagic events and median post-surgical hospital stay were compared between groups.
  
  
  RESULTS
  TIMI Bleeding index was not significantly difference between the clopidogrel and not clopidogrel groups (mean difference 0.46; 95% CI -0.89 to 1.82; p = 0.5). The incidence of major TIMI bleeding (70% vs. 73.5%; p > 0.9), peak hemoglobin loss > 5 g/dL (60% vs. 38.2%; p = 0.2), and blood transfusion > 4 units (20% vs. 26.5%; p = 0.7) in clopidogrel vs. no-clopidogrel group were not statistically different. Interestingly, the post-surgical length of stay was longer for the no-clopidogrel group (median of 5 vs. 7 days; p = 0.006).
  
  
  CONCLUSIONS
  There was no significant evidence of increased bleeding or need for blood transfusion during CABG in patients pretreated with clopidogrel. The current practice of clopidogrel pretreatment before percutaneous coronary intervention does not significantly increase the risk of hemorrhagic complications in stable patients provided they can wait for at least 7 days before CABG. In a single center retrospective study, clopidogrel pretreatment was not found to be associated with increased bleeding or need for blood transfusion during coronary artery bypass graft surgery, suggesting that clopidogrel pretreatment before percutaneous coronary intervention does not significantly increase the risk of hemorrhagic complication in stable patients provided they can wait for 7 days before the surgery.
authors.affiliation: Department of Medicine, University of klahoma Health Sciences Center, Oklahoma City.
authors.forename: Shradha
authors.initials: S
authors.lastname: Rathi
authors.forename: Pedro
authors.initials: P
authors.lastname: Lozano
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Boeckman
authors.forename: J Emilio
authors.initials: JE
authors.lastname: Exaire
mesh_terms: D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine