Does Clopidogrel Increase Blood Loss Following Coronary Artery Bypass Surgery?

Introduction Clopidogrel treatment is associated with a reduction in thrombotic complications in coronary stent placement, improved outcome after acute coronary syndromes and de- creased mortality in patients with coronary artery disease. The purpose of this study was to analyze the effect of preoperative clopidogrel exposure on bleeding complica- tions, blood transfusion requirement and reoperations and ICU and ward stay and me- diastinitis in patients undergoing coronary artery bypass grafting (CABG). Materials and Methods: This study included 82 patients from a single institution (Shahid Rajaie Hospital) that underwent an isolated CABG who were discharged 2010. The cohort of 82 patients was classified into 2 groups. The control group consisted of 46 patients that did not receive clopidogrel or stopped 5 days before surgery but were treated with aspirin and clopidogrel group consisted of 36 patients that were taking clopidogrel within 5 days of surgery. Patients were compared based on preoperative data (age, gender, use of clopidogrel, ejection fraction), intraoperative data (cross clamp CPB time) and postoperative data (chest tube output, rate of reoperation, units of transfused blood length of stay in the intensive care unit and ward). Results: There were no significant differences among 2 groups concerning age, sex and ejec- tion fraction. There were no differences in length of intensive care unit and ward stay among 2 groups. Patients in clopidogrel group had more units of platelet transfusion than the control group (P=0.001). There is also a non significant trend toward more chest tube output in clopidogrel group compared with the control group, the mean chest tube output in clopidogrel group was 1185±850 ml and in control group was 1020±590 ml (P=0.305). 7 patients of the total group required reoperation secondly to bleeding, 5 patients in clopidogrel group (13.9%) and 2 patients (4.3%) in control group but was not significant statistically (P=0.125). Conclusions: This study demonstrated that clopidogrel within 5 days preoperatively increases the requirement for platelet transfusion and packed cell transfusion only in clopidogrel group that needed reoperation for hemostasis. The reoperation rate of patients that took clopidogrel within 5 days of their procedure was not different from reoperation rate of the patients that did not take clopidogrel. Our results don t support the recent history of clopidogrel treatment associated with increased blood loss. Transfusion and reoperation was required after CABG.