Key result
Stopping DAPT two days before OPCAB is linked to an ~8-fold higher re-exploration rate versus six days.
Why the study?
The study was conducted to review the effect of preoperative clopidogrel and aspirin use on perioperative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting.
Does discontinuing aspirin and clopidogrel 2-5 days prior to surgery increase peri-operative bleeding and transfusion requirements compared to 6 days in patients undergoing off-pump CABG?
Observational (n=1,200)
No
Does discontinuing aspirin and clopidogrel 2-5 days prior to surgery increase peri-operative bleeding and transfusion requirements compared to 6 days in patients undergoing off-pump CABG?
Absolute Event Rate: 9.01% vs 1.07%
p-value: p=< 0.001
Discontinuing clopidogrel and aspirin at least 6 days prior to off-pump CABG significantly reduces peri-operative bleeding, blood transfusion requirements, and the need for re-exploration compared to shorter discontinuation intervals.
Short antiplatelet discontinuation before off-pump CABG was associated with higher re-exploration; hypothesis-generating for optimal timing pending randomized trials.
Purpose: The purpose of this study was to review the effect of the pre-operative use of clopidogrel and aspirin on peri-operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG). Materials and Methods: A total of 1200 patients who underwent off-pump CABG (OPCABG) between 2010 and 2012 were retrospectively studied. Patients were divided into three groups: group 1: discontinued aspirin and clopidogrel 6 days prior to surgery (n = 468), group 2: discontinued both drugs 3 to 5 days prior to surgery (n = 621), and group 3: discontinued both drugs 2 days prior to surgery (n = 111). The bleeding pattern and blood product transfusion were studied and compared between the groups. Patients having history of other drugs affecting the coagulation profile, other organ dysfunction, on-pump CABG, and the combined procedure were excluded from the study. Results: Group 2 patients had a higher rate of bleeding and a reduced mean value of hemoglobin (Hb) as compared to other groups. The same results were seen in blood and blood product transfusion. Patients of group 2 and group 3 were associated with higher blood loss in terms of drainage at 12 and 24 hours. Post-operatively, this was statistically significant. Re-exploration was statisitically significant in group 3 patients (9.01%) than in group 2 (2.58%) and group 1 (1.07%) patients. Conclusion: The pre-operative use of clopidogrel and aspirin in patients undergoing OPCABG showed limited clinical benefits; however, its use significantly increased the risk of bleeding and blood transfusion, thus increasing morbidity and resource utilization. Hence, clopidogrel and aspirin should be stopped at least 6 days prior to surgery.
No takes yet. Share an insight, caveat, or question.
Kapoor et al. (2022) conducted an observational in Off-pump coronary artery bypass grafting (OPCABG) (n=1,200). Discontinuation of aspirin and clopidogrel 2 days prior to surgery vs. Discontinuation of aspirin and clopidogrel 6 days prior to surgery was evaluated on Re-exploration rate (p=< 0.001). Discontinuing clopidogrel and aspirin 2 days prior to off-pump coronary artery bypass grafting significantly increased the re-exploration rate to 9.01%, compared to 1.07% when discontinued 6 days prior.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: