title: Impact of preoperative fibrinogen concentration on postoperative outcome in patients who received dual antiplatelet therapy in proximity to off-pump coronary bypass surgery.
abstract: BACKGROUND
  Preoperative fibrinogen concentration is associated with increased blood loss at the lower end, and with hypercoagulability-related ischemic event at the higher end in cardiac patients. We evaluated the influence of preoperative fibrinogen concentration on blood loss and outcome in patients who received clopidogrel in proximity to off-pump coronary artery bypass surgery (OPCAB).
  
  
  RESULTS
  Medical records of 538 patients who received clopidogrel within 5 days of OPCAB (April 2007 to March 2012) were retrospectively reviewed. Perioperative bleeding and composite of morbidity endpoints including myocardial infarction were compared in relation to the tertile distribution of the fibrinogen concentration. The amount of blood loss was significantly larger in the first tertile, whereas the incidence of composite of morbidity endpoints was significantly higher in the third tertile. In multivariate analysis for risk factors of perioperative blood loss, body mass index and duration of surgery were identified as independent risk factors but not the fibrinogen level. And hypertension and preoperative fibrinogen level were identified as independent risk factors about composite of morbidity. The third tertile was associated with a 2-fold increased risk of developing composite of morbidity endpoints.
  
  
  CONCLUSIONS
  In patients who received dual antiplatelet therapy in proximity to OPCAB, increased preoperative fibrinogen concentration could serve as a valuable predictor for composite of morbidity endpoints, whereas low fibrinogen concentration was not found to be a risk factor of bleeding.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine.
authors.forename: Na Young
authors.initials: NY
authors.lastname: Kim
authors.forename: Jae-Kwang
authors.initials: JK
authors.lastname: Shim
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Song
authors.forename: Eui-Kyung
authors.initials: EK
authors.lastname: Kim
authors.forename: Young-Lan
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D000077144:Clopidogrel; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011300:Preoperative Care; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D005340:Fibrinogen; D000077144:Clopidogrel; D013988:Ticlopidine