| Coronary bypass surgery in patients treated with clopidogrel. Is it safe? | |
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MedLine Citation:
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PMID: 19684514 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE OF REVIEW: Current guidelines for the management of acute coronary syndrome clearly recommend that clopidogrel should be started before diagnostic coronary angiography. If patients undergo coronary artery bypass grafting (CABG) early after clopidogrel loading or during continued exposure, it seems reasonable to expect an increase in bleeding complications. RECENT FINDINGS: Earlier studies may have overestimated the risk of bleeding in patient undergoing CABG with prior clopidogrel exposure (5-10-fold increase). Some conflicting results are reported in literature. As reexploration because of excessive bleeding is concerned, a two to three-fold increase must be expected, which is demonstrated in actual trials properly matched to confounding factors. Discontinuation of clopidogrel for 5-7 days prior to urgent CABG as recommended by guidelines is not well adopted in clinical practice for several reasons. SUMMARY: There is a moderately elevated risk of bleeding complications after CABG due to prior clopidogrel exposure alone. However, in clinical practice this risk is added often to patients who carry already elevated surgical risks (urgent procedures, worse coronary anatomy, history of previous myocardial infarction and prior percutaneous intervention), and after bleeding complications singular patients may suffer from consecutive adverse outcome. Cessation of clopidogrel in patients before CABG clearly prolongs hospitalization time and has an estimated 1% risk of coronary events during the waiting period. Risk and benefit have to be balanced in every individual case. |
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Authors:
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Thierry Carrel; Lars Englberger |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Current opinion in cardiology Volume: 24 ISSN: 1531-7080 ISO Abbreviation: Curr. Opin. Cardiol. Publication Date: 2009 Nov |
Date Detail:
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Created Date: 2010-01-14 Completed Date: 2010-03-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8608087 Medline TA: Curr Opin Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 539-43 Citation Subset: IM |
Affiliation:
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Department of Cardiovascular Surgery, University Hospital Berne (Inselspital), Berne, Switzerland. thierry.carrel@insel.ch |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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therapy* Coronary Angiography Coronary Artery Bypass / adverse effects* Hemorrhage / chemically induced* Humans Platelet Aggregation Inhibitors / adverse effects*, therapeutic use Risk Factors Ticlopidine / adverse effects, analogs & derivatives*, therapeutic use Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Platelet Aggregation Inhibitors; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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