Postoperative blood loss in patients undergoing coronary artery bypass surgery after preoperative treatment with clopidogrel. A prospective randomised controlled study

Abstract

Continuation of clopidogrel until the day of surgery induces significantly more postoperative blood loss and increases significantly the total requirements of homologous blood products and FFP transfusion after surgery. The blood loss and the use of blood products in the group that stopped at 3 days preoperatively were similar to that of the group that stopped at 5 days preoperatively.

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

“…Patients in the continuation group experienced increased rates of bleeding and blood product utilization, but the 3-and 5-day discontinuation groups had comparably low bleeding rates and blood product usage that resembled historical control values. 413 In a retrospective analysis of a nonrandomized subgroup of patients in the PLATO trial, in which several definitions of bleeding were used, no significant differences in CABG-related bleeding were observed between patients allocated ticagrelor and patients who received clopidogrel, and there were no observed differences in the rates of reoperation. 401 In contrast, among the relatively few patients with STEMI in TRITON-TIMI 38 who underwent CABG during the 15-month course of the study, rates of TIMI major or minor bleeding after CABG were significantly higher with prasugrel than with clopidogrel (21.9% versus 4.1%; OR: 6.53; 95% CI: 1.78 to 23.94; P=0.0032).…”

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…164,165 Nevertheless, minor (primarily pharyngeal injury from probe insertion) and major (esophageal perforation, gastric bleeding, or late mediastinitis) complications are reported. 166,167 A more indolent complication is that of acquired dysphagia and possible aspiration postoperatively. Although retrospective analyses of postoperative cardiac surgical patients with clinically manifest esophageal dysfunction have identified TEE use as a risk factor, 168 -170 such dysfunction also has been reported in subjects in whom TEE was not used.…”

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…The magnitude of bleeding risk when CABG is performed 1 to 4 days after the discontinuation of clopidogrel is less certain. Although the incidence of lifethreatening bleeding does not appear to be significantly increased during this time, an increase in blood transfusions is likely (523,524,529,531). Accordingly, from the perspective of blood conservation, it is reasonable to delay elective CABG for Ն5 days after discontinuing clopidogrel.…”