Key result
A 600 mg loading dose of clopidogrel before emergent CABG significantly increased postoperative bleeding compared to no clopidogrel (625 cc vs 400 cc, p=0.005), whereas a 300 mg dose did not.
Why the study?
Does clopidogrel loading dose increase postoperative bleeding in patients with acute coronary syndrome requiring emergent coronary bypass surgery?
Cohort (n=61)
No
Does clopidogrel loading dose increase postoperative bleeding in patients with acute coronary syndrome requiring emergent coronary bypass surgery?
A 600 mg loading dose of clopidogrel before emergent CABG in ACS patients significantly increases postoperative bleeding compared to no clopidogrel, whereas a 300 mg dose does not appear to increase bleeding risk.
Answers are grounded in this paper and cite their sources.
May support avoiding 600 mg clopidogrel loading before emergent CABG; leaves open safety of 300 mg dosing in ACS.
Background: This study aims to evaluate the effect of high dose clopidogrel administered before coronary angiography in patients with the diagnosis of acute coronary syndromes (ACS) requiring emergent coronary angiography and emergent coronary artery bypass graft (CABG) surgery on postoperative bleeding and other complications. Methods: A total of 1800 consecutive patients who underwent CABG between October 2007 and October 2010 in our clinic were retrospectively analyzed. A total of 61 patients (44 males, 17 females; mean age 63±10 years; range 42 to 79 years) were enrolled including 21 of them without clopidogrel, 20 with clopidogrel 300 mg and 20 with clopidogrel 600 mg due to ACS. All of the patients underwent emergent angiography due to ACS. All of them underwent CABG surgery within minimum two hours and maximum 18 hours. Postoperative bleeding, reoperation due to bleeding, length of stay in the intensive care unit (ICU) and hospital and early-term mortality of the patients were compared. Results: No significant difference in the amount of bleeding was observed between the postoperative chest tube drainages of patients who received clopidogrel 300 mg compared to the patients who received no clopidogrel therapy (450cc, 400cc, respectively, p>0.05). The amount of bleeding was significantly higher in patients who received clopidogrel 600 mg compared to patients who received no clopidogrel therapy (625cc, 400cc, respectively p0.05). The length of stay in the ICU and hospital were similar in all three groups. Conclusion: Patients who received loading dose of clopidogrel 300 mg due to ACS may undergo CABG surgery after emergent angiography. Postoperative bleeding may not be a critical challenge in these patients. However patients who receive loading dose of clopidogrel 600 mg are at high risk for postoperative bleeding and complications compared to patients not receiving clopidogrel.
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Kemalettin Erdem (2012) conducted a cohort in Acute coronary syndrome requiring emergent CABG (n=61). Clopidogrel vs. No clopidogrel was evaluated on Postoperative chest tube drainage (amount of bleeding) (p=0.005). A 600 mg loading dose of clopidogrel before emergent CABG significantly increased postoperative bleeding compared to no clopidogrel (625 cc vs 400 cc, p=0.005), whereas a 300 mg dose did not.
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