title: Bleeding outcomes in patients given clopidogrel within 5 days of robotic coronary artery bypass graft procedure.
abstract: BACKGROUND
  Current guidelines recommend that clopidogrel should be held for 5 days prior to coronary artery bypass graft (CABG) procedure. However, it is unknown if this recommendation should apply to robotic-assisted (rCABG), which is less invasive because it does not involve sternotomy and thus reduces the risk of bleeding.
  
  
  OBJECTIVE
  To compare postoperative bleeding for rCABG patients who were taking clopidogrel within 5 days of the procedure with those who were not taking clopidogrel.
  
  
  METHODS
  This was a retrospective cohort study conducted between January 1, 2012 and December 31, 2012 of consecutive patients undergoing rCABG. Patients were categorized into 2 groups based on whether or not clopidogrel was administered within 5 days prior to the date of surgery. The primary outcome measure was the occurrence of the Bleeding Academic Research Consortium (BARC) definition for CABG-related bleeding. The secondary outcome measure was a comparison of chest tube output during the first 24-hour postoperative period.
  
  
  RESULTS
  A total of 136 rCABG patients were included in the final analyses. Of these, 39 (29%) received clopidogrel within 5 days of surgery. CABG-related bleeding using the BARC definition occurred in 26% of patients who received clopidogrel and 8% of patients who did not (P = .011). Median chest tube output during the first 24-hour postoperative period was also greater in patients who received clopidogrel (900 vs 735 mL, P = .002).
  
  
  CONCLUSIONS
  The use of clopidogrel within 5 days of rCABG is associated with greater postoperative bleeding and chest tube output, as defined by the BARC criteria.
authors.affiliation: University of Arizona, Tucson, AZ, USA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Vainrub
authors.forename: Asad E
authors.initials: AE
authors.lastname: Patanwala
authors.forename: Richard
authors.initials: R
authors.lastname: Cosgrove
authors.forename: Robert
authors.initials: R
authors.lastname: Poston
authors.forename: Paul E
authors.initials: PE
authors.lastname: Nolan
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000368:Aged; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D012371:Robotics; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: bleeding; clopidogrel; coronary artery bypass; platelet aggregation inhibitors