Effect of clopidogrel on perioperative blood loss and transfusion in coronary artery bypass graft surgery

Badreldin, Akmal M.A.; Kroener, Axel; Kamiya, Hiroyuki; Lichtenberg, Artur; Hekmat, Khosro

doi:10.1510/icvts.2009.211805

Cited by 29 publications

(17 citation statements)

References 14 publications

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“…[22][23][24] Other types of procedures, such as simple endoscopy, [25][26][27] cardiothoracic surgery, [28][29][30] and spinal instrumentation and fusion surgery, 31 were not associated with a substantial increase in blood loss and related complications. We speculate that prolonged bleeding may complicate procedures performed in open anatomic spaces, such as the gastrointestinal tract or the pharynx, whereas closed spaces, such as the spine, may provide better conditions for clot formation, even when platelet activity is disturbed.…”

Section: Discussionmentioning

confidence: 97%

Blood loss and complications following carotid endarterectomy in patients treated with clopidogrel

Chechik¹,

Goldstein²,

Behrbalk³

et al. 2012

Vascular

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This study assessed the effect of uninterrupted antiplatelet therapy on perioperative blood loss and complications in patients undergoing carotid endarterectomy. The files of 107 consecutive patients (mean age 69.5 ± 9 years; range 47-88; 78 men) who underwent carotid endarterectomy were reviewed. Twenty-six patients had been treated with clopidogrel (16 of whom were on combined clopidogrel and aspirin treatment) and compared with non-clopidogrel patients. Antiplatelet treatment was continued until the day of surgery without interruption. Perioperative blood loss and complications were studied. The mean hemoglobin decrease was 1.64 ± 1.2 mg/dL and was not significantly affected by clopidogrel. Surgical time was significantly longer among patients treated with clopidogrel (205 ± 52 minutes on combined treatment and 201 ± 68 minutes on clopidogrel alone versus 165 ± 33 minutes, P < 0.0001). Postoperative complications were similar for all groups and included five strokes, five neck hematomas, one nerve injury and one wound infection. In conclusion, patients treated with clopidogrel before carotid endarterectomy can be expected to have prolonged surgical time. Large cohorts are required to determine whether these patients have more complications.

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Section: Discussionmentioning

confidence: 97%

Blood loss and complications following carotid endarterectomy in patients treated with clopidogrel

Chechik¹,

Goldstein²,

Behrbalk³

et al. 2012

Vascular

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show abstract

“…Advanced age has been a validated transfusion risk factor in two recent scoring systems [21,22]. Platelet receptor inhibitor use of clopidogrel 5 days or less before surgery is also an established risk factor for bleeding [23]. …”

Section: Discussionmentioning

confidence: 99%

Does incorporation of thromboelastography improve bleeding prediction following adult cardiac surgery?

Sharma

Al-Achi

Seccombe

et al. 2014

Blood Coagulation &Amp; Fibrinolysis

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Cardiopulmonary bypass (CPB) coagulopathy increases utilization of allogenic blood/blood products, which can negatively affect patient outcomes. Thromboelastography (TEG) is a point-of-care measurement of clot formation and fibrinolysis. We investigated whether the addition of TEG parameters to a clinically based bleeding model would improve the predictability of postoperative bleeding. A total of 439 patients’ charts were retrospectively investigated for 8-h chest tube output (CTO) postoperatively. For model 1, the variables recorded were patient age, gender, body surface area, clopidogrel use, CPB time, first post-CPB fibrinogen serum level, first post-CPB platelet count, first post-CPB international normalized ratio, the total amount of intraoperative cell saver blood transfused, and postoperative first ICU hematocrit level. Model 2 had the model 1 variables, TEG angle, and maximum amplitude. The outcome was defined as 0–8-h CTO. The predictor variables were placed into a forward stepwise regression model for continuous outcomes. Analysis of variance with adjusted R2 was used to assess the goodness-of-fit of both predictive models. The predictive accuracy of the model was examined using CTO as a dichotomous variable (75th percentile, 480 ml) and receiver operating characteristic curves for both models. Advanced age, male gender, preoperative clopidogrel use for 5 days or less, greater cell saver blood utilization, and lower postoperative hematocrit levels were associated with increased 8-h CTO (P < 0.05). Adding TEG angle and maximum amplitude to model 1 did not improve CTO predictability. When TEG angle and maximum amplitude were added as predictor factors, the predictability of the bleeding model did not improve.

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“…Because it irreversibly inactivates platelets its effect is not eliminated until the patient replaces his/her platelet supply. Clopidogrel administration has been associated with increased bleeding following coronary artery bypass surgery (CABG), and the current American guidelines currently recommend a five-day waiting period prior to elective surgical procedures due to this complication [8-12]. The frequent need for emergent CABG in the ACS population has led to controversy about the safety of the procedure in the setting of clopidogrel exposure [13].…”

Section: Introductionmentioning

confidence: 99%

Ticagrelor versus Genotype-Driven Antiplatelet Therapy for Secondary Prevention after Acute Coronary Syndrome: A Cost-Effectiveness Analysis

et al. 2011

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Background Clopidogrel’s effectiveness is likely reduced significantly for prevention of thrombotic events after acute coronary syndrome (ACS) in patients exhibiting a decreased ability to metabolize clopidogrel into its active form. A genetic mutation responsible for this reduced effectiveness is detectable by genotyping. Ticagrelor is not dependent on gene-based metabolic activation and demonstrated greater clinical efficacy than clopidogrel in a recent secondary prevention trial. In 2011, clopidogrel will lose its patent protection and likely will be substantially less expensive than ticagrelor. Objective To determine the cost-effectiveness of ticagrelor compared with a genotype-driven selection of antiplatelet agents. Methods A hybrid decision tree/Markov model was used to estimate the 5-year medical costs (in 2009 US$) and outcomes for a cohort of ACS patients enrolled in Medicare receiving either genotype-driven or ticagrelor-only treatment. Outcomes included life years and quality-adjusted life years (QALYs) gained. Data comparing the clinical performance of ticagrelor and clopidogrel were derived from the Platelet Inhibition and Patient Outcomes trial. Results The incremental cost-effectiveness ratio (ICER) for universal ticagrelor was $10,059 per QALY compared to genotype-driven treatment, and was most sensitive to the price of ticagrelor and the hazard ratio for death for ticagrelor compared with clopidogrel. The ICER remained below $50,000 per QALY until a monthly ticagrelor price of $693 or a 0.93 hazard ratio for death for ticagrelor relative to clopidogrel. In probabilistic analyses, universal ticagrelor was below $50,000 per QALY in 97.7% of simulations. Conclusion Prescribing ticagrelor universally increases quality-adjusted life years for ACS patients at a cost below a typically accepted threshold.

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Effect of clopidogrel on perioperative blood loss and transfusion in coronary artery bypass graft surgery

Cited by 29 publications

References 14 publications

Blood loss and complications following carotid endarterectomy in patients treated with clopidogrel

Blood loss and complications following carotid endarterectomy in patients treated with clopidogrel

Does incorporation of thromboelastography improve bleeding prediction following adult cardiac surgery?

Ticagrelor versus Genotype-Driven Antiplatelet Therapy for Secondary Prevention after Acute Coronary Syndrome: A Cost-Effectiveness Analysis

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