Impact of Preoperative Clopidogrel Administration on Perioperative Blood Loss and Transfusion Requirements in Patients Undergoing Coronary Artery Bypass Graft Surgery

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Clopidogrel is an adenosine-5' diphosphate (ADP) receptor antagonist that eventually inhibits platelet aggregation. It is used concomitantly with percutaneous coronary interventions and in patients with acute coronary diseases. This study was conducted to determine the effects of preoperative clopidogrel administration on perioperative blood loss and transfusion requirements in patients undergoing coronary artery bypass graft (CABG) surgery.Methods: For 100 patients who underwent nonurgent first-time coronary artery bypass grafting surgery participated in this study. clopidogrel was discontinued in 2, 3, 5-6 or 7-8 days before surgery. A cell salvage device was used during surgery and salvaged blood was recorded. After surgery, chest tube output and need for blood transfusion were measured and recorded.Findings: Patients' mean age was 61.7 ± 8.0 years (range: 50 to 77). There was a reverse relation between the time clopidogrel had been discontinued and blood loss and need for transfusion of packed cell and blood products during and after surgery (P < 0.05 for all).Conclusion: Preoperative clopidogrel administration increases perioperative blood loss and need for blood transfusion in patients undergoing coronary artery bypass grafting surgery.

Keywords

References

  1. Kam PC, Nethery CM. The thienopyridine derivatives (platelet adenosine diphosphate receptor antagonists), pharmacology and clinical developments. Anaesthesia 2003; 58(1): 28-35.
  2. Steinhubl SR, Berger PB, Mann JT, III, Fry ET, DeLago A, Wilmer C, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 2002; 288(19): 2411-20.
  3. Bertrand ME, Rupprecht HJ, Urban P, Gershlick AH. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: the clopidogrel aspirin stent international cooperative study (CLASSICS). Circulation 2000; 102(6): 624-9.
  4. Muller C, Buttner HJ, Petersen J, Roskamm H. A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary-artery stents. Circulation 2000; 101(6): 590-3.
  5. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996; 348(9038): 1329-39.
  6. Moshfegh K, Redondo M, Julmy F, Wuillemin WA, Gebauer MU, Haeberli A, et al. Antiplatelet effects of clopidogrel compared with aspirin after myocardial infarction: enhanced inhibitory effects of combination therapy. J Am Coll Cardiol 2000; 36(3): 699-705.
  7. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345(7): 494-502.
  8. Ascione R, Ghosh A, Rogers CA, Cohen A, Monk C, Angelini GD. In-hospital patients exposed to clopidogrel before coronary artery bypass graft surgery: a word of caution. Ann Thorac Surg 2005; 79(4): 1210-6.
  9. Chu MW, Wilson SR, Novick RJ, Stitt LW, Quantz MA. Does clopidogrel increase blood loss following coronary artery bypass surgery? Ann Thorac Surg 2004; 78(5): 1536-41.
  10. Filsoufi F, Rahmanian PB, Castillo JG, Kahn RA, Fischer G, Adams DH. Clopidogrel treatment before coronary artery bypass graft surgery increases postoperative morbidity and blood product requirements. J Cardiothorac Vasc Anesth 2008; 22(1): 60-6.
  11. Hongo RH, Ley J, Dick SE, Yee RR. The effect of clopidogrel in combination with aspirin when given before coronary artery bypass grafting. J Am Coll Cardiol 2002; 40(2): 231-7.
  12. Kapetanakis EI, Medlam DA, Boyce SW, Haile E, Hill PC, Dullum MK, et al. Clopidogrel administration prior to coronary artery bypass grafting surgery: the cardiologist's panacea or the surgeon's headache? Eur Heart J 2005; 26(6): 576-83.
  13. Nurozler F, Kutlu T, Kucuk G, Okten C. Impact of clopidogrel on postoperative blood loss after non-elective coronary bypass surgery. Interact Cardiovasc Thorac Surg 2005; 4(6): 546-9.
  14. Ray JG, Deniz S, Olivieri A, Pollex E, Vermeulen MJ, Alexander KS, et al. Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel. BMC Cardiovasc Disord 2003; 3: 3.
  15. Yende S, Wunderink RG. Effect of clopidogrel on bleeding after coronary artery bypass surgery. Crit Care Med 2001; 29(12): 2271-5.
  16. Fox KA, Mehta SR, Peters R, Zhao F, Lakkis N, Gersh BJ, et al. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome: the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) Trial. Circulation 2004; 110(10): 1202-8.
  17. Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. BMJ 1994; 308(6921): 81-106.
  18. Alexander JH, Harrington RA, Tuttle RH, Berdan LG, Lincoff AM, Deckers JW, et al. Prior aspirin use predicts worse outcomes in patients with non-ST-elevation acute coronary syndromes. PURSUIT Investigators. Platelet IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy. Am J Cardiol 1999; 83(8): 1147-51.
  19. Mitka M. Results of CURE trial for acute coronary syndrome. JAMA 2001; 285(14): 1828-9.
  20. Mishkel GJ, Aguirre FV, Ligon RW, Rocha-Singh KJ, Lucore CL. Clopidogrel as adjunctive antiplatelet therapy during coronary stenting. J Am Coll Cardiol 1999; 34(7): 1884-90.
  21. Jarvis B, Simpson K. Clopidogrel: a review of its use in the prevention of atherothrombosis. Drugs 2000; 60(2): 347-77.
  22. Weber AA, Braun M, Schrör K. Recovery of platelet function after discontinuation of clopidogrel treatment in healthy volunteers. Br J Clin Pharmacol 2001; 52(3): 333-6.
  23. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124(23): 2610-42.
Journal of Isfahan Medical School
Volume 31, Issue 270 - Serial Number 270
November and December 2014
Pages 2382-2389

Files

History

  • Receive Date: 21 September 2013
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics