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Effects of a Waiting Period After Clopidogrel Treatment Before Performing Coronary Artery Bypass Grafting
Author(s) -
Reichert Marc G.,
Robinson Amanda H.,
Travis Jeffrey A.,
Hammon John W.,
Kon Neal D.,
Kincaid Edward H.
Publication year - 2008
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.28.2.151
Subject(s) - medicine , clopidogrel , intensive care unit , artery , anesthesia , cardiopulmonary bypass , single center , coronary artery bypass surgery , bypass grafting , blood transfusion , surgery , cardiology , myocardial infarction
Study Objective. To assess the effects of a waiting period after clopidogrel treatment before coronary artery bypass grafting (CABG). Design. Single‐center, prospective, observational study. Setting. Cardiothoracic surgery intensive care unit at a university‐affiliated medical center. Patients. One hundred consecutive patients who received clopidogrel and were scheduled to undergo primary CABG. In 64 of these patients, CABG was delayed at least 5 days after clopidogrel treatment (group A). The other 36 patients received clopidogrel treatment within 5 days of undergoing CABG (group B). Measurements and Main Results. Data were collected on patient demographics, time of last clopidogrel dose, preoperative anticoagulant and/or antiplatelet agents administered, surgical characteristics, intraoperative transfusions, blood products transfused, and chest tube output for 24 hours after surgery. No significant differences in baseline characteristics or intraoperative variables (number of bypasses, aortic cross‐clamp time, and cardiopulmonary bypass time) were noted between the two groups. Mean ± SD number of packed red blood cell units/patient was 1.1 ± 1.4 in group A versus 2.1 ± 2.5 in group B (p=0.009). Mean ± SD number of platelet units/patient transfused was 0.5 ± 0.9 in group A versus 1.9 ± 1.6 in group B (p <0.001). When comparing a subset of 21 patients who received clopidogrel within 72 hours of surgery with the 64 whose CABG was delayed at least 5 days after clopidogrel treatment, the transfusion rates were significantly higher (95% vs 52%, p<0.05). Specifically, the mean ± SD number of transfused units/patient of red blood cells (3.1 ± 2.8 vs 1.1 ± 1.4, p<0.005) and platelets (2.6 ± 1.5 vs 0.5 ± 0.9, p<0.007) was greater in patients who received clopidogrel within 72 hours of surgery. Conclusion. A strategy to delay CABG after clopidogrel treatment led to reduced blood product administration. The optimal waiting period after clopidogrel treatment is not known but appears to be at least 5 days before CABG.