Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel

Abstract

Background: The administration of antiplatelet drugs before coronary artery bypass graft surgery (CABG) is associated with an increased risk of major hemorrhage and related surgical reexploration. Little is known about the relative effect of combined clopidogrel and aspirin on blood product use around the time of CABG. We evaluated the associated risk between the combined use of aspirin and clopidogrel and the transfusion of blood products perioperatively.

The rationale for platelet transfusion during cardiopulmonary bypass: an observational study

“…13,18 Age was similar in both patient populations; thus, the effect of older age could not be shown. As this was an observational study, the lack of significant effect of thienopyridines may be due to confounding variables that were not controlled or perhaps due to the fact that patients receiving thienopyridines had elective CABG surgery which is not associated with as high a risk of bleeding as, for example, valvular surgery.…”

“…The questionnaire incorporated questions about physician characteristics, the hospital setting for the platelet transfusion (preoperative, intraoperative, or postoperative), and factors that could potentially affect the physician's decision to transfuse platelets, i.e., the platelet count, bleeding (rate and volume), type of surgery, preoperative use of antiplatelet agents, hemodynamic instability, results of thromboelastography, renal function, and duration of CPB. The factors were selected from a literature search, [11][12][13][14] from consultation with experts in cardiac surgery, and from the pilot study. The physicians were asked to choose factors from this list that influenced their decision to transfuse platelets and to rank the factors in order of importance.…”

“…Variables consistently found to be associated with an increased rate of platelet transfusion include older age, previous cardiac surgery, bleeding, preoperative use of anti-platelet agents, and the platelet count. [12][13][14] Other factors that have been found to be associated with a higher rate of transfusion include duration of CPB, the preoperative hemoglobin concentration, the preoperative creatinine level, and preoperative heart failure. 12 The indications for platelet transfusion during cardiac surgery need to be clarified as currently there are no definitive indications for platelet transfusion, and a high proportion of patients are being exposed to the adverse events of transfusion due to a high utilization of platelet transfusions in cardiac surgery.…”

Spinal anaesthesia despite combined clopidogrel and aspirin therapy in a patient awaiting lung transplantation: effects of platelet transfusion on clotting tests

“…Thus, no guidelines exist for administration of central neural blockade in patients receiving combination antiplatelet therapy, although dual application of clopidogrel and aspirin significantly increases bleeding time [10]. In addition, in patients with such dual anticoagulant treatment undergoing coronary artery bypass grafting there is an increased loss of blood, requiring more transfusions of red blood cells, plasma, and platelets, and these patients have to be reoperated on more frequently due to bleeding [11,12]. The increased bleeding time and the increased risk of haemorrhage therefore warrant the exercise of caution with spinal or epidural puncture in patients receiving platelet inhibition, in particular when combined with aspirin.…”

Η Επίδραση Της Στρατηγικής Περιορισμού Των Ενδοφλεβίως Χορηγούμενων Υγρών Στον Αριθμό Των Μεταγγιζόμενων Μονάδων Συμπυκνωμένων Ερυθρών Στις Καρδιοχειρουργικές Επεμβάσεις Με Εξωσωματική Κυκλοφορία

“…Επειδή η κλοπιδογρέλη, είναι τόσο καλά ανεκτή και η θεραπεία πριν την εµφύτευση της ενδοπρόθεσης δίνει πλεονέκτηµα στη βατότητα της στεφανιαίας αρτηρίας, είναι κοινή πρακτική οι ασθενείς που υποβάλλονται σε επείγουσα ή υπερεπείγουσα CABG να λαµβάνουν άµεσα προεγχειρητικά διπλή αντιαιµοπεταλικακή θεραπεία µε ασπιρίνη και κλοπιδογρέλη. Αυτή η διπλή θεραπεία, αν και είναι ασφαλής και αποτελεσµατική κατά τις στεφανιαίες παρεµβάσεις [314][315][316][317], είχε σαν αποτέλεσµα µεγαλύτερη µετεγχειρητική αιµορραγία, περισσότερα µεταγγιζόµενα προιόντα αίµατος και υψηλότερο ποσοστό επανεπέµβασης για διερεύνηση µεσοθωρακικής αιµορραγίας κατά την CABG [319][320][321][322]. Οι τρέχουσες κατευθυντήριες οδηγίες της ACC/AHA καθώς και οι τρέχουσες STS κατευθυντήριες οδηγίες, συστήνουν τη διακοπή των αναστολέων ADP 5-7 ηµέρες πριν την καρδιοχειρουργική επέµβαση, αν είναι δυνατόν, διότι είναι κοινά αποδεκτό ότι η επέµβαση πριν τις 5 ηµέρες σε ασθενείς που λαµβάνουν ADP-αναστολείς ενέχει αυξηµένο τον κίνδυνο για µετεγχειρητική αιµορραγία και µετάγγιση, ενώ οδηγεί πιθανώς σε χειρότερη έκβαση µακροπρόθεσµα [302,322].…”