Vol.3 - No.2

Does Clopidogrel Increase Blood Loss Following Coronary Artery Bypass Surgery?

By : sadeghpur, khamushi, rezaei, BehnamAskari

Keywords : CABG; clopidogrel; postoperative blood loss

Clopidogrel treatment is associated with a reduction in thrombotic complications in
coronary stent placement, improved outcome after acute coronary syndromes and decreased
mortality in patients with coronary artery disease. The purpose of this study
was to analyze the effect of preoperative clopidogrel exposure on bleeding complications,
blood transfusion requirement and reoperations and ICU and ward stay and mediastinitis
in patients undergoing coronary artery bypass grafting (CABG).

Methods

This study included 82 patients from a single institution (Shahid Rajaie Hospital) that
underwent an isolated CABG who were discharged 2010. The cohort of 82 patients
was classified into 2 groups. The control group consisted of 46 patients that did not
receive clopidogrel or stopped 5 days before surgery but were treated with aspirin and
clopidogrel group consisted of 36 patients that were taking clopidogrel within 5 days
of surgery.
Patients were compared based on preoperative data (age, gender, use of clopidogrel,
ejection fraction), intraoperative data (cross clamp & CPB time) and postoperative
data (chest tube output, rate of reoperation, units of transfused blood length of stay in
the intensive care unit and ward).

Results

There were no significant differences among 2 groups concerning age, sex and ejection
fraction. There were no differences in length of intensive care unit and ward stay
among 2 groups. Patients in clopidogrel group had more units of platelet transfusion
than the control group (P=0.001). There is also a non significant trend toward more
chest tube output in clopidogrel group compared with the control group, the mean
chest tube output in clopidogrel group was 1185±850 ml and in control group was
1020±590 ml (P=0.305). 7 patients of the total group required reoperation secondly
to bleeding, 5 patients in clopidogrel group (13.9%) and 2 patients (4.3%) in control
group but was not significant statistically (P=0.125).

Conclusion

This study demonstrated that clopidogrel within 5 days preoperatively increases the
requirement for platelet transfusion and packed cell transfusion only in clopidogrel
group that needed reoperation for hemostasis. The reoperation rate of patients that took
clopidogrel within 5 days of their procedure was not different from reoperation rate of
the patients that did not take clopidogrel.
Our results don't support the recent history of clopidogrel treatment associated with
increased blood loss. Transfusion and reoperation was required after CABG.

References

1 Associate professor of cardiac surgery, Department of Cardiac surgery, Rajaei Heart Center, Tehran, Iran

2 Resident of cardiac surgery Department of Cardiac surgery, Rajaei Heart Center, Tehran, Iran,

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