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.
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?
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.
Absolute Event Rate: 9.01% vs 1.07%
p-value: p=< 0.001
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.
Kapoor et al. (Fri,) conducted a 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.