Clopidogrel‐Associated Bleeding and Related Complications in Patients Undergoing Coronary Artery Bypass Grafting

Abstract

Clopidogrel exposure within 7 days before CABG is associated with an increase in major bleeding, hemorrhage-related complications, and transfusion requirements, and leads to potentially greater consumption of health care resources. The overall risks and benefits for each patient should be considered before using the drug.

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

“…150,151 Continuation of DAPT until CABG increases the risk of excessive perioperative bleeding, transfusions, and re-exploration for bleeding as shown in RCTs, 147,150,151 observational studies, 152,153 and metaanalyses. 154,155 Therefore, it is recommended that the P2Y 12 inhibitor be discontinued whenever possible before elective CABG. 156,157 Alternatively, elective operations may be postponed until the DAPT treatment period is completed.…”

Bleeding complications after pacemaker or cardioverter-defibrillator implantation in patients receiving dual antiplatelet therapy

“…There are several reports on the increased rate of bleeding complications in patients receiving clopidogrel or DAT who undergo CABG, general surgery or transbronchial biopsy. 9,10,11,13 Although the consequences of bleeding complications after CIED implantation are usually lower than those associated with cardiosurgery or neurosurgery, pocket bleeding may result in pocket infection or endocarditis. On the other hand, the indications for CIED implantation have expanded.…”

PCI, Stents, Clopidogrel and Non‐cardiac Surgery

“…Most cardiac surgeons believe there will be an increased need for transfusions, and this may be the case in patients with acute coronary syndromes operated without the usual discontinuation of clopidogrel 5 to 10 days prior to surgery. 2 However, the data are limited and as far as I can tell, there are no large, randomized clinical trials that address this problem.…”