Document Detail


Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery.
MedLine Citation:
PMID:  20103308     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Christine R Herman; Karen J Buth; Blaine A Kent; Gregory M Hirsch
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-02-17     Revised Date:  2010-09-30    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  397-402     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiac Surgery, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Blood Transfusion*
Cardiopulmonary Bypass
Coronary Artery Bypass*
Coronary Artery Bypass, Off-Pump
Drug Administration Schedule
Female
Heart Valve Prosthesis Implantation*
Humans
Male
Middle Aged
Odds Ratio
Platelet Aggregation Inhibitors / administration & dosage,  adverse effects*
Postoperative Hemorrhage / chemically induced*,  therapy
Preoperative Care
Retrospective Studies
Risk
Risk Factors
Ticlopidine / administration & dosage,  adverse effects,  analogs & derivatives*
Grant Support
ID/Acronym/Agency:
//Canadian Institutes of Health Research
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel
Comments/Corrections
Comment In:
Ann Thorac Surg. 2010 Oct;90(4):1391; author reply 1391-2   [PMID:  20868862 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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