Clopidogrel does not increase postoperative bleeding risk in patients with Acute Coronary Syndrome
Sep 5, 2007 - 8:39:45 AM
, Reviewed by: Dr. Rashmi Yadav
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By European Heart Journal,
[RxPG] Aspirin combined with clopidogrel is the treatment of choice for acute coronary syndromes. Although the maintenance of aspirin until surgery does not affect postoperative bleeding after coronary artery bypass graft (CABG) surgery, the latter may be dramatically increased when clopidogrel is continued over a period of 5 days preoperatively.
This prospective observational study included 217 consecutive patients scheduled for first-time CABG. Postoperative bleeding and blood transfusion requirements were compared (equivalence) between patients pretreated during a period of 5 days prior surgery by either aspirin alone (n = 157) or combined with clopidogrel (n = 60).
Aprotinin was systematically used in all these patients considered as high risk for bleeding.
The authors found no significant difference between both groups concerning the preoperative characteristics except for unstable angina (33 vs. 19%, P = 0.02) and left main coronary artery stenosis (27 vs. 13%, P = 0.02), which were more frequent in patients receiving clopidogrel.
The median chest tube output was similar in both groups 24 h postoperatively at 350 mL (95% CI 150–850) vs. 375 mL (95% CI 175–875), and the difference between groups (7%, 95% CI –9 to 22) did not encompass the predetermined margins of equivalence (25%). No significant difference was found on blood transfusion use (38 vs. 38%, P = 0.99). After adjustment by a propensity score, it was found that clopidogrel was not associated with an increased risk of excessive bleeding.
The sudy concluded that in patients undergoing first-time CABG and treated prophylactically with aprotinin, aspirin and clopidogrel may be continued until surgery without increasing postoperative bleeding or transfusion requirements.
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About Dr. Rashmi Yadav
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This news story has been reviewed by Dr. Rashmi Yadav before its publication on RxPG News website. Dr. Rashmi Yadav, MBBS, is a senior editor for RxPG News. In her position she is responsible for managing special correspondents and the surgery section of the website. Her areas of special interest include cardiothoracic surgery and interventional radiology.
RxPG News is committed to promotion and implementation of Evidence Based Medical Journalism in all channels of mass media including internet.
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Additional information about the news article
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The study appears in European Heart Journal Advance Access originally published online on April 12, 2007.
The authors involved in the study 'Impact of aspirin with or without clopidogrel on postoperative bleeding and blood transfusion in coronary surgical patients treated prophylactically with a low-dose of aprotinin' are
Alexandre Ouattara1, Hassine Bouzguenda1, Yannick Le Manach, Philippe Léger, Anne Mercadier, Pascal Leprince, Nicolas Bonnet, Gilles Montalescot, Bruno Riou and Pierre Coriat.
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