Combined clopidogrel and aspirin treatment up to surgery increases the risk of postoperative myocardial infarction, blood loss and reoperation for bleeding in patients undergoing coronary artery bypass grafting.
OBJECTIVE
Recent guidelines suggest that patients undergoing coronary artery bypass grafting (CABG) should discontinue clopidogrel and aspirin (ASA) 5 and 2-10 days, respectively, before surgery to reduce postoperative bleeding and its complications. The aim of our study was to evaluate the relationship between the timing of discontinuing clopidogrel + ASA and early clinical outcomes in patients undergoing CABG.


METHODS
Four thousand three hundred and thirty consecutive patients underwent isolated CABG from April 2004 to February 2009. Of these, 926 patients received double antiplatelet therapy in the 14 days prior to surgery. Patients were stratified into three groups: clopidogrel + ASA within 5 and 2 days, respectively, before surgery (Group A, n = 287); clopidogrel within 5 days + ASA stopped 2-10 days before surgery or clopidogrel stopped 5 days + ASA within 2 days of surgery (Group B, n = 308) and clopidogrel + ASA discontinued >5 and 10 days, respectively, before surgery (control group, n = 331).


RESULTS
Overall mortality was 0.8%. The incidence of postoperative myocardial infarction (MI) was 5.2, 1 and 1.8% in Groups A, B and control, respectively (P = 0.004). Reoperation for bleeding occurred in 4.5, 2.9 and 1.2% (P = 0.04) and total chest drainage was 761 ± 473, 720 ± 421 and 687 ± 302 ml in Groups A, B and control, respectively (P = 0.06). Multivariable analysis revealed that Group A was an independent predictor of postoperative MI (P = 0.02), reoperation for bleeding (P = 0.02), blood transfusions (P = 0.003) and blood losses (P = 0.015).


CONCLUSIONS
Clopidogrel in combination with ASA up to the time of surgery is associated with an increased risk of postoperative MI, blood loss and reoperation for bleeding in patients undergoing CABG.
Bristol Heart Institute, University of Bristol, Bristol, UK.
Antonio
A
Miceli
Simon M J
SM
Duggan
Giuseppe
G
Aresu
Paolo M
PM
de Siena
Francesco
F
Romeo
Mattia
M
Glauber
Massimo
M
Caputo
Gianni D
GD
Angelini
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000453:epidemiology*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006113:United Kingdom / Q000453:epidemiology
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin