Original article
Adult cardiac
Clopidogrel Increases Blood Transfusion and Hemorrhagic Complications in Patients Undergoing Cardiac Surgery

https://doi.org/10.1016/j.athoracsur.2009.10.051Get rights and content

Background

Utilization of the irreversible antiplatelet agent clopidogrel is increasing in the treatment acute coronary syndrome patients. Consequently, more patients are presenting for urgent cardiac surgery with an irreversible defect in platelet function. The objective of this study was to determine whether recent clopidogrel administration predicts transfusion and hemorrhagic complication in cardiac surgery patients.

Methods

This retrospective study included all patients undergoing isolated coronary artery bypass graft surgery (CABG), isolated valve, or CABG plus valve at a single center between 2004 and 2008. The outcomes of interest were transfusion and hemorrhagic complication. Clopidogrel stop interval was defined as the time between last dose and presentation to the operating room, and was examined in daily increments from 0 to 5 days, more than 5 days, and not receiving clopidogrel preoperatively. By logistic regression, the association of clopidogrel stop interval with transfusion and with hemorrhagic complication was examined after adjusting for other risk factors.

Results

Of 3,779 patients included in this study, 26.4% (999) received clopidogrel preoperatively. The overall rates of transfusion and hemorrhagic complication were 34.1% and 4.1%, respectively. Clopidogrel use within 24 hours was an independent predictor of transfusion (odds ratio 2.4; 95% confidence interval: 1.8 to 3.3) and of hemorrhagic complication (odds ratio 2.1; 95% confidence interval: 1.3 to 3.6).

Conclusions

Patients receiving clopidogrel within 24 hours of surgery are at increased risk for transfusion and hemorrhagic complication. Timing of surgery for patients receiving clopidogrel should take into account the interval from the last dose.

Section snippets

Material and Methods

Approval for conducting this study was obtained by the Instituitonal Review Board of the Capital District Health Authority. We note that the need for individual patient consent for this study was waived by the Review Board.

Patient Population

This study included 3,779 consecutive patients undergoing isolated CABG, isolated valve surgery, or CABG plus valve surgery. In the study, 26.4% of patients (999) received clopidogrel preoperatively and of those, 74.3% (742) presented to the operating room within 5 days of receiving clopidogrel. Compared with patients not prescribed clopidogrel, preoperative clopidogrel use was associated with higher transfusion (43.6% [436] versus 30.7% [854], p = 0.0001) and hemorrhagic complication (4.9%

Comment

The objective of this study was to determine the relationship between the outcomes of interest and the clopidogrel stop interval. We found that patients receiving clopidogrel within 24 hours of surgery experienced significantly higher transfusion rates and that transfusion rates decreased as the clopidogrel stop interval increased. Using logistic regression, we identified clopidogrel administration within 24 hours of surgery as an independent predictor of blood product transfusion (OR 2.4) and

References (21)

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