Key result
Preoperative continuous administration of clopidogrel did not increase the rate of reexploration for bleeding compared to discontinuation in patients with acute coronary syndrome undergoing off-pump coronary artery bypass surgery.
Why the study?
Does continuous preoperative administration of clopidogrel increase hemorrhagic complications in patients with acute coronary syndrome undergoing off-pump coronary artery bypass surgery?
Observational (n=172)
No
Does continuous preoperative administration of clopidogrel increase hemorrhagic complications in patients with acute coronary syndrome undergoing off-pump coronary artery bypass surgery?
Continuous preoperative clopidogrel administration does not increase the risk of hemorrhagic complications in ACS patients undergoing isolated OPCAB, suggesting surgery need not be delayed.
Answers are grounded in this paper and cite their sources.
Supports uninterrupted preoperative clopidogrel in ACS OPCAB without excess bleeding; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Clopidogrel has become standard treatment after urgent percutaneous coronary revascularization. Due to its enhanced and irreversible platelet inhibition, patients undergoing urgent surgical revascularization have a higher risk of bleeding complications and transfusions. Therefore, the effect of preoperative continuous administration of clopidogrel on the incidence of hemorrhagic complications in patients undergoing off-pump coronary artery bypass surgery with acute coronary syndrome was evaluated. METHODS AND RESULTS: From March 2004 to September 2006, 172 patients with acute coronary syndrome underwent isolated off-pump coronary artery bypass surgery; 70 (40.7%) and 102 (59.3%) of these patients did or did not take clopidogrel before surgery respectively. Seventy patients in each group were matched using propensity scores and associations between preoperative continuous administration of clopidogrel and postoperative bleeding, hemostatic reoperation, blood products received, the need for multiple transfusions and early graft patency by coronary computed tomography were assessed. Univariate analysis showed the continuous clopidogrel group had similar levels of postoperative bleeding for 24 h (601.4+/-312.6 ml vs 637.2+/-452.4 ml, p=0.616) and rates of reexploration (1.4% vs 1.4%), perioperative blood transfusion (33.3% vs 34.3%, p>0.05) and platelet transfusion (2.9% vs 7.1%, p=0.44) compared with the non-continuous group. CONCLUSIONS: Preoperative continuous administration of clopidogrel did not increase the risk of hemorrhagic complications in patients with acute coronary syndrome undergoing isolated off-pump coronary artery bypass surgery. These findings indicate that surgery after clopidogrel treatment in patients with acute coronary syndrome should not be delayed until platelet function returns to normal because they may have a higher risk of recurrent myocardial ischemic events.
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Song et al. (2007) conducted an observational in Acute coronary syndrome (n=172). Continuous preoperative clopidogrel vs. Discontinuation of clopidogrel at least 3 days before surgery was evaluated on Need for reexploration as a result of bleeding (p=1.00). Preoperative continuous administration of clopidogrel did not increase the rate of reexploration for bleeding compared to discontinuation in patients with acute coronary syndrome undergoing off-pump coronary artery bypass surgery.
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