Pre-operative clopidogrel use cautioned for cardiac patients
MedWire News: Study findings highlight the risk for bleeding complications in patients who undergo coronary artery bypass graft (CABG) surgery within a day of clopidogrel treatment.
Patients were twice as likely to experience bleeding complications or require transfusion if they had received clopidogrel within 24 hours than if they had not, demonstrates research published in the Annals of Thoracic Surgery.
“We recommend that if the clinical situation allows, for patients receiving clopidogrel, undergoing cardiac surgery should be delayed at least 24 hours,” say Gregory Hirsch and co-workers, from the Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia, Canada.
The team examined the outcomes of 3799 patients who underwent CABG surgery with or without valve surgery, or valve surgery alone, at a single centre between 2004 and 2008.
Overall, 26.4% of patients received clopidogrel before surgery, the majority (74.3%) of whom received treatment within 5 days of the procedure. Clopidogrel was given within 24 hours of surgery to 8.6% of patients and within 48 hours to 3.2%.
Bleeding complications, defined as tamponade or re-exploration for bleeding, occurred in 4.1% of patients, and 34.1% required a blood product transfusion.
Analysis showed that patients who underwent surgery within 24 hours of being given a clopidogrel dose were significantly more likely to experience bleeding complications and require transfusion than patients not using clopidorel, with odds ratios (ORs) of 2.1 and 2.4, respectively.
Patients given clopidogrel within 48 hours of surgery were also more likely to require transfusion (OR=1.7) but not to experience bleeding complications.
“For cardiac surgery patients, clopidogrel administration should be restricted to those with clear-cut indications for its use,” Hirsch et al conclude.
“For patients with a high likelihood of surgical intervention, consideration should be given to delaying clopidogrel loading until relevant diagnostic studies can be obtained that will determine the role for urgent cardiac surgical intervention.”
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By Lynda Williams