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J Am Coll Cardiol, 2002; 40:231-237 © 2002 by the American College of Cardiology Foundation |
* Division of Cardiology, California Pacific Medical Center, San Francisco, California, USA
Manuscript received November 20, 2001; revised manuscript received April 8, 2002, accepted April 18, 2002.
* Reprint requests and correspondence: Dr. Rupsa R. Yee, Division of Cardiology, California Pacific Medical Center, 2333 Buchanan Street, San Francisco, California 94115, USA.
phillimx{at}sutterhealth.org
OBJECTIVES: This study was designed to evaluate the effect of preoperative clopidogrel on coronary artery bypass graft surgery (CABG) outcomes.
BACKGROUND: Clopidogrel in combination with aspirin, given before percutaneous coronary intervention, has become the standard for stent thrombosis prevention. Some premedicated patients, however, are found to have surgical disease on angiography, and irreversible platelet inhibition becomes a concern for upcoming CABG.
METHODS: We prospectively studied 224 consecutive patients undergoing nonemergent first-time CABG, and compared those with preoperative clopidogrel exposure within seven days (n = 59) to those without exposure (n = 165).
RESULTS: The groups were comparable in age, gender, body surface area, preoperative hematocrit, preoperative prothrombin time and prior myocardial infarction. The clopidogrel group had higher 24-h mean chest tube output (1,224 ml vs. 840 ml, p = 0.001), and more transfusions of red blood cells (2.51 U vs. 1.74 U, p = 0.036), platelets (0.86 U vs. 0.24 U, p = 0.001) and fresh frozen plasma (0.68 U vs. 0.24 U, p = 0.015). Moreover, reoperation for bleeding was 10-fold higher in the clopidogrel group (6.8% vs. 0.6%, p = 0.018). The clopidogrel group also had less extubation within 8 h (54.2% vs. 75.8%, p = 0.002) and a trend towards less hospital discharge within five days (33.9% vs. 46.7%, p = 0.094).
CONCLUSIONS: Clopidogrel in combination with aspirin before CABG is associated with higher postoperative bleeding and morbidity. These findings raise concern regarding the routine administration of clopidogrel before anticipated coronary stent implantation.
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|
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|
|
|
|
|
|
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|
|
|
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|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
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|
|
|
|
|
|
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|
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|
|
 |
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|
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