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Heart attack |
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Dosage |
Packing |
Price |
Pay now |
75 mg |
100 tab |
USD 49.00 |
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Research articles |
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Eur Heart J. 2005 Mar;26(6):576-83.
Epub 2005 Feb 21.
Clopidogrel administration prior
to coronary artery bypass grafting surgery: the cardiologist's panacea or
the surgeon's headache?
Kapetanakis EI, Medlam
DA, Boyce SW, Haile E, Hill PC, Dullum MK, Bafi AS, Petro KR, Corso PJ.
Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center,
106 Irving Street, NW, Suite 316, Washington, DC 20010-2975, USA.
AIMS: Thrombotic complications after percutaneous coronary intervention
procedures have decreased in past years mainly due to the use of clopidogrel
antiplatelet therapy. However, the risk of bleeding due to enhanced and
irreversible platelet inhibition in patients who will require surgical coronary
revascularization instead has not been adequately addressed in the literature.
The purpose of this study was to evaluate the effect of pre-operative clopidrogel
exposure in haemorrhage-related re-exploration rates, peri-operative transfusion
requirements, morbidity, and mortality in patients undergoing coronary artery
bypass grafting (CABG) surgery. METHODS AND RESULTS: A study population
of 2359 patients undergoing isolated CABG between January 2000 and June
2002 was reviewed. Of these, 415 (17.6%) received clopidogrel prior to CABG
surgery, and 1944 (82.4%) did not. A risk-adjusted logistic regression analysis
was used to assess the association between clopidogrel pre-medication (vs.
no) and haemostatic re-operation, intraoperative and post-operative blood
transfusion rates, and multiple transfusions received. Haemorrhage-related
pre-operative risk factors identified from the literature and those found
significant in a univariate model were used. Furthermore, a sub-cohort,
matched-pair by propensity scores analysis, was also conducted. The clopidogrel
group had a higher likelihood of haemostatic re-operation [OR=4.9, (95%
CI, 2.63-8.97), P<0.01], an increase in total packed red blood cell transfusions
[OR=2.2, (95% CI, 1.70-2.84), P<0.01], multiple unit blood transfusions
[OR=1.9, (95% CI, 1.33-2.75), P<0.01] and platelet transfusions [OR=2.6,
(95% CI, 1.95-3.56), P<0.01]. Surgical outcomes and operative mortality
[OR=1.5, (95% CI, 0.36-6.51), P=0.56] were not significantly different.
CONCLUSION: Pre-operative clopidogrel exposure increases the risk of haemostatic
re-operation and the requirements for blood and blood product transfusion
during, and after, CABG surgery.
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