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Effect of clopidogrel on bleeding after coronary artery bypass surgery

Yende, Sachin MD; Wunderink, Richard G. MD

CLINICAL INVESTIGATIONS
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Objective  Platelet dysfunction is a common cause of bleeding after coronary artery bypass graft surgery. This study explores the effects of clopidogrel on bleeding complications after coronary artery bypass graft surgery.

Design  Prospective observational study of patients undergoing coronary artery bypass graft.

Setting  Tertiary care center.

Patients  A total of 247 patients undergoing coronary artery bypass graft surgery.

Interventions  None.

Measurements  Primary end point was need for reexploration secondary to bleeding. Secondary end points included need for transfusion of blood products and chest tube output.

Main results  Eight (3.3%) of 247 patients required reexploration secondary to bleeding. Clopidogrel recipients had higher incidence of reexploration for bleeding (9.8 vs. 1.6, p = .01) with an odds ratio of 6.9 (95% confidence interval, 1.6–30). Clopidogrel also increased the percentage of patients receiving packed red blood cell transfusion (72.6 vs. 51.6%, p = .007), the number of packed red blood cell units (3 vs. 1.6, p =0.0004), and the number of cryoprecipitate units (2.4 vs. 1.2, p = .04) transfused after coronary artery bypass graft surgery. Among clopidogrel recipients, a trend for increased transfusion of platelet units (4.3 vs. 1.7, p = .05) and fresh frozen plasma units (1.1 vs. 0.6, p = .08) also was found.

Conclusions  Preoperative use of clopidogrel in combination with aspirin is associated with increased need for surgical reexploration as well as risk of packed red blood cell and cryoprecipitate transfusions after coronary artery bypass graft surgery.

From the Physician Research Network, Methodist Healthcare, Memphis, TN.

Supported, in part, by Methodist-Lebonheur Healthcare Foundation, Memphis, TN.

Platelet transfusions should be the standard for patients exposed to clopidogrel, despite normal platelet counts.

© 2001 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins