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CLOPIDOGREL AND BLEEDING AFTER CORONARY ARTERY BYPASS GRAFT SURGERY
Jee-Yoong Leong MB BS, Vijit Cherian MCh, Robert A Baker PhD, John L Knight FRACS
Cardiac and Thoracic Surgical Unit, Flinders Medical Centre, Bedford Park, South Australia, AUSTRALIA
Background. Aspirin is the main antiplatelet medication used in patients with coronary artery disease, however there is growing evidence that the use of the more potent clopidogrel, on its own or in combination with aspirin, has superior outcomes. Clopidogrel has also been shown to increase the risk of bleeding after coronary artery bypass graft surgery, which is a significant cause of morbidity and mortality. We review the effect of the use of preoperative clopidogrel on bleeding-related complications after coronary artery bypass graft surgery in our institution.
Methods. A retrospective analysis of all patients undergoing isolated coronary artery bypass graft surgery at the Flinders Medical Centre between July 2000 and June 2003. A comparison was made between patients who received preoperative clopidogrel with those who did not receive it. Also, a comparison was made between patients who were on clopidogrel only, aspirin only and neither medication.
Results. A total of 919 patients were identified, of which 88 (9.6%) were on preoperative clopidogrel. Clopidogrel recipients had a higher volume of drain loss, were transfused more units of blood, and had longer intensive care unit and postoperative hospital stays than patients not exposed to clopidogrel.
Conclusions. In the three year period studied, the data from our institution showed an increased risk of bleeding, blood transfusion and resource utilization in patients who were on clopidogrel before coronary artery bypass graft surgery.
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