Key result
Continuing clopidogrel until less than 48 hours before coronary artery bypass graft surgery did not increase postoperative chest tube drainage or bleeding complications compared to stopping it 48 to 120 hours prior.
Why the study?
Many patients presenting for CABG remain on preoperative DAPT, but the impact of continuing DAPT until 48 hours versus 48 to 120 hours before surgery on postoperative complications required evaluation.
Does continuing clopidogrel until 48 hours before CABG increase postoperative bleeding complications and mortality compared to stopping it 48 to 120 hours before surgery?
Cohort (n=192)
No
Does continuing clopidogrel until 48 hours before CABG increase postoperative bleeding complications and mortality compared to stopping it 48 to 120 hours before surgery?
Answers are grounded in this paper and cite their sources.
Continuing dual antiplatelet therapy until 48 hours prior to CABG surgery was not associated with a significant increase in postoperative bleeding complications or mortality compared to stopping 48-120 hours prior.
Background: Majority of the patients presenting for coronary artery bypass surgery are preoperatively on clopidogrel and aspirin i.e., Dual antiplatelets therapy (DAPT) because of high incidence of left main stem disease, acute coronary syndrome and diffuse coronary artery disease. Preceding coronary stenting and coming from far flung areas even from other countries with poor socioeconomic status contributes to continuation of DAPT till surgery. The main objective of the study was to evaluate hospital complications like chest tube output, re-explorations, blood, and blood product administration and in-hospital mortality in patients who continued DAPT till 48 hours prior to surgery versus those who continued DAPT until 48 to 120 hours before surgery. Methods: Preoperative history, perioperative and postoperative data of patients was gathered retrospectively from 1st July to 31st December 2019 in a tertiary care hospital of Peshawar. Total patients undergoing CABG Surgery were 223. From those 223 patients 192 patients were on DAPT. We than divided the 192 patients into two groups, Group A and Group B. 102 patients (Group A) received clopidogrel plus aspirin until 48 hours before surgery, and 89 patients (Group B) continued clopidogrel 48 to 120 hours prior to surgery. Chest tube output, need for exploration, in-hospital mortality, and blood or products transfusions among both groups were compared. Results: In terms of bleeding complications no significant difference between the both groups with similar chest drainage in the first 24 hours (602 ml and 609ml). In group A 33 patients received blood transfusion compared to 25 patients from group B. There was no significant difference in the amount of platelets given to group A (0.63 L) and to group B was (0.60 L). On the other hand, Group, A received 1.08 L fresh frozen plasma (FFPs) transfusion and group B 1.10 L respectively. Re-exploration was observed in Group A and B as (3 vs 2). Mortality was observed in 7 patients from group A and 2 from Group B. Conclusions: Usage of Dual antiplatelets therapy (DAPT) before surgery was an effective treatment method for postoperative complication of bleeding. It was suggested that with proper management with DAPT before surgery was planned is an effective and safe treatment method..
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Shahid et al. (2021) conducted a cohort in Coronary Artery Disease requiring CABG (n=192). Stopping clopidogrel <48 hours before CABG vs. Stopping clopidogrel 48 to 120 hours before CABG was evaluated on Chest drain output (p=0.796). Continuing clopidogrel until less than 48 hours before coronary artery bypass graft surgery did not increase postoperative chest tube drainage or bleeding complications compared to stopping it 48 to 120 hours prior.
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