Eur J Cardiothorac Surg 2004;25:419-423
© 2004 Elsevier Science NL
Clopidogrel does not increase bleeding and allogenic blood transfusion in coronary artery surgery
Hasan Karabuluta*, Fevzi Toramana, Serdar Evrenkayaa, Onur Gokselb, Sumer Tarcana, Cem Alhana
a Department of Cardiovascular Surgery, Ac
badem Hospital, Tekin Sokak, No. 8, 34718 Acbadem, Istanbul, Turkey
b Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
Received 17 August 2003; received in revised form 20 November 2003; accepted 27 November 2003.
* Corresponding author. Tel.: +90-216-5444-214; fax: +90-216-3258-759
e-mail: hasankarabulut@turk.net
Objectives: Platelet dysfunction is one of the major reasons
of postoperative bleeding following coronary artery surgery.
The aim of this study was to evaluate the effects of clopidogrel;
a specific and potent irreversible inhibitor of platelet aggregation;
on bleeding and use of blood and blood products after coronary
artery bypass surgery (CABG).
Methods: Preoperative patient
characteristics and perioperative and postoperative data were
collected prospectively in 1628 consecutive patients undergoing
isolated CABG performed by the same surgical and anesthesia
team. Of these, 48 were receiving clopidogrel preoperatively.
Of the 1628 patients, 1456 underwent elective and 172 (10.6%)
underwent non-elective operation. Thirty-six (2.5%) of the elective
patients and 12 (7%) of the non-elective patients were using
clopidogrel, preoperatively. Baseline characteristics, chest
tube output, and the need for reexploration or for blood and
blood product transfusion of clopidogrel recipients and non-recipients
were compared. The clopidogrel group had higher prothrombin
time level (12.6±1.6; 11.5±1.7 s, P=0.013), however
comparable aPTT level (32.6±4.5 vs. 31.4±4.5 s),
and platelet count (275 000±98 000 vs. 280 000±72
000 dl
-1).
Results: The need for reexploration or for blood
and blood product transfusion, chest tube output, ICU length
of stay (20.1±2.9 vs. 21.9±13.5 h; P=NS), and
hospital length of stay (5.5±1.7 vs. 5.4±2.1 days;
P=NS) were similar in clopidogrel recipients and non-recipients,
respectively. Further analysis demonstrated no significant difference
in use of homologous blood or fresh frozen plasma, amount of
postoperative bleeding and reoperation rates for bleeding as
well as length of intensive care unit and hospital stay between
the clopidogrel and the control groups both in elective and
non-elective patients.
Conclusions: The results of this study
suggest that preoperative use of clopidogrel is not associated
with increased bleeding and need for surgical exploration as
well as risk of blood and blood product transfusion after CABG.
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