Performing CABG 1-2 days after clopidogrel cessation was associated with higher odds of blood product transfusion compared to waiting ≥5 days (OR 2.52; 95% CI 1.32-4.83).
Cohort (n=472)
No
Does clopidogrel discontinuation 1-4 days prior to CABG increase bleeding and transfusion requirements compared to ≥ 5 days in patients treated with clopidogrel?
A waiting period of at least 5 days between clopidogrel cessation and CABG is associated with lower transfusion requirements, supporting current guideline recommendations.
Effect estimate: OR 2.52 (95% CI 1.32-4.83)
Objectives Current guidelines advise stopping clopidogrel at least 5 days prior to coronary artery bypass grafting (CABG) in patients with acute coronary syndrome to lower bleeding risk. However, this delay may increase the risk of cardiovascular events. This study evaluated the impact of clopidogrel discontinuation timing on bleeding and postoperative outcomes. Methods This retrospective single‐center study analyzed data from 472 patients treated with clopidogrel who underwent CABG. Patients were grouped based on the duration between clopidogrel cessation and surgery: 1–2 days ( n = 42), 3–4 days ( n = 89), and ≥ 5 days ( n = 341). Outcomes included bleeding complications and transfusion requirements. Results No significant difference was found in clinically substantial bleeding (defined as chest tube drainage > 800 mL within 12 h postsurgery) among the groups ( p = 0.45). However, earlier surgery was associated with greater transfusion requirements. Patients operated on within 1–2 days had 2.52 times higher odds of requiring blood product transfusion (95% CI: 1.32–4.83), and those at 3–4 days had 1.69 times higher odds (95% CI: 1.05–2.71), compared to those with ≥ 5 days. Conclusions In this single‐center cohort, a waiting period of at least 5 days between clopidogrel cessation and CABG was associated with lower transfusion requirements, without a clear increase in early clinically substantial bleeding, thereby supporting current guideline recommendations for stable patients.
Friedman et al. (jeu,) ont mené une cohorte chez des patients traités par clopidogrel subissant un pontage aortocoronarien (n=472). L'arrêt du clopidogrel 1-2 jours avant la chirurgie par rapport à l'arrêt du clopidogrel ≥ 5 jours avant la chirurgie a été évalué sur les besoins en transfusion de produits sanguins (OR 2.52, IC 95 % 1.32-4.83). La réalisation du pontage aortocoronarien 1-2 jours après l'arrêt du clopidogrel était associée à des cotes plus élevées de transfusion de produits sanguins par rapport à l'attente ≥ 5 jours (OR 2.52 ; IC 95 % 1.32-4.83).