title: Assessing Intraoperative Bleeding Risk in Patients Undergoing Coronary Artery Bypass Grafting with Prior Exposure to Clopidogrel: Single Center Retrospective Analysis.
abstract: In patients undergoing coronary artery bypass grafting (CABG), intraoperative and postoperative major bleeding requiring blood transfusions and surgical reexploration is associated with increased mortality and morbidity. Our study hypothesized that exposure to clopidogrel is not significantly associated with increased risk for intraoperative bleeding, even when administered less than 5 days before CABG. We also aimed to determine variables associated with intraoperative packed red blood cell (iPRBC) transfusion. Patients of both sexes aged 18 years or older who underwent CABG from July 1, 2011 to December 31, 2012 were included in the analysis. Study population consisted of 2 groups-clopidogrel arm and nonclopidogrel arm. Patients were included in clopidogrel arm if they were exposed to clopidogrel in the past (as one of their home medications or received the medication for first time during the index hospitalization), whereas patients who never received clopidogrel were included in nonclopidogrel arm. We identified a total of 303 adult patients who underwent CABG with a mean age was 64.5 years. Mortality rate in our study was 0.99% (n = 3) with increased mortality in women as compared with men (3.27% vs. 0.41%, P = 04). The mean iPRBC transfused were 1.68 units, with higher units being transfused in women as compared with men (2.23 vs. 1.49 units, respectively, P = 0.03) and no significant difference between clopidogrel and nonclopidogrel arms (1.92 vs. 1.50, respectively, P = 0.18). After multivariate analysis, age [odds ratio (OR) = 1.03, P = 0.01], female sex (OR = 2.61, P = 0.006) and hypertension (OR = 7.10, P = 0.02) predicted increased iPRBC transfusion. Clopidogrel or nonclopidogrel status was not associated with increased iPRBC transfusion (OR = 1.06, P = 0.81). iPRBC transfusion rates were similar in both arms with age, female sex, and hypertension being an independent predictor of iPRBC transfusion.
authors.affiliation: 1Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY; 2Division of Cardiology, Department of Medicine, Lehigh Valley Health Network, Allentown, PA; and 3Department of Cardiothoracic surgery, Westchester Medical Center, New York Medical College, Valhalla, NY.
authors.forename: Kevin
authors.initials: K
authors.lastname: Chen
authors.forename: Jalaj
authors.initials: J
authors.lastname: Garg
authors.forename: Ramin
authors.initials: R
authors.lastname: Malekan
authors.forename: David
authors.initials: D
authors.lastname: Spielvogel
authors.forename: Hasan
authors.initials: H
authors.lastname: Ahmad
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine