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Ann Thorac Surg 2004;78:1536-1541
© 2004 The Society of Thoracic Surgeons
a Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada
b Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
Accepted for publication March 8, 2004.
* Address reprint requests to Dr Quantz, Division of Cardiac Surgery, University Campus, LHSC, Room 6OF3, 339 Windermere Rd, London, Ontario N6A 5A5, Canada
maquantz{at}uwo.ca
BACKGROUND: Clopidogrel (Plavix) is a potent inhibitor of platelet aggregation used concomitantly with percutaneous coronary interventions and in patients with acute coronary syndromes. Its favorable effects on preventing thrombus formation may have deleterious effects on hemostasis in patients undergoing coronary surgery.
METHODS: Data were collected prospectively on 312 consecutive urgent or emergent coronary artery bypass patients from July 1999 through April 2001 at a tertiary care center. Patients were stratified into three groups: clopidogrel within 4 days of operation (n = 41), clopidogrel continued until 5 to 8 days before operation (n = 39), and clopidogrel discontinued more than 8 days before operation or were never taking clopidogrel (n = 232).
RESULTS: Preoperative and intraoperative characteristics were similar among all groups. Mediastinal and pericardial chest tube losses in the first 24 hours were 1,044 ± 750 mL in the clopidogrel within 4 days group, 528 ± 250 mL in the clopidogrel 5 to 8 days group, and 573 ± 329 mL in the clopidogrel more than 8 days group (p < 0.01). The mean total blood product transfusions were 12.2 ± 15.4 U, 1.2 ± 2.0 U, and 2.6 ± 5.7 U, respectively (p < 0.001). Reoperation for bleeding was noted in 14.6%, 2.6%, and 1.7%, respectively (p = 0.002). The median hospital lengths of stay for the three groups were 9 days, 7 days, and 7 days, respectively (p = 0.018). There were no statistically significant differences in mortality rate, myocardial infarction, stroke, mediastinitis, or postoperative renal failure among the groups. Multivariable analysis revealed that clopidogrel within 0 to 4 days of operation was an independent predictor of transfusion requirements (OR 4.22, 95% confidence interval [CI] 2.07, 9.34, p = 0.001), intensive care unit (ICU) length of stay (OR 3.14, 95% CI 1.40, 7.04, p = 0.006), and total hospital length of stay (coefficient 7.65, se 2.41, p = 0.002).
CONCLUSIONS: Clopidogrel within 4 days of coronary bypass surgery is associated with increased blood losses and reoperation for bleeding and, according to multivariable models, is an independent risk factor for increased transfusion requirements and prolonged ICU and hospital length of stay.
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