Journal of Thrombosis and Thrombolysis

, Volume 34, Issue 1, pp 56–64 | Cite as

Bleeding-associated outcomes with preoperative clopidogrel use in on- and off-pump coronary artery bypass

  • Jeffrey S. Berger
  • Peter M. Herout
  • Qing Harshaw
  • Steven R. Steinhubl
  • Carla B. Frye
  • Richard C. Becker
Article
First Online:

Abstract

Clopidogrel use prior to coronary artery bypass graft surgery in patients presenting with acute coronary syndromes is associated with a greater incidence of procedural related morbidity. We studied the impact of clopidogrel pre-treatment in patients undergoing off-pump versus on-pump coronary revascularization. This report describes a post hoc analysis of 431 on-pump and 165 off-pump cases from a retrospective multicenter study of the impact of preoperative (within 5 days) clopidogrel use on bleeding related outcomes and surgical reintervention. Logistic regression was used to analyze the outcomes with respect to surgery type and clopidogrel exposure while using a propensity score risk adjustment for off-pump surgery. The hospital length of stay (9.3 ± 5.4 days vs. 8.9 ± 5.3 days, p = 0.35), major bleeding (21% vs. 20%, p = 0.74) and reoperation (3.7% vs. 4.8%, p = 0.53) were similar between on-pump and off-pump, respectively. In both surgical cohorts, recent clopidogrel use was associated with a greater incidence of major bleeding, reoperation, and transfusion. After multivariable adjustment, the odds ratio of major bleeding (1.76, 95% confidence interval 0.88–3.52 on-pump; 2.37, 95% confidence interval 1.06–5.30 off-pump) and reoperation (4.52, 95% confidence interval 0.58–36.6 in on-pump; 7.05, 95% confidence interval 0.82–60.5 in off-pump) was increased in clopidogrel-treated patients compared to no clopidogrel. Major bleeding and reoperation did not differ significantly between patients undergoing on- or off-pump surgery. Clopidogrel treatment within 5 days prior to surgery increased the risk of bleeding and reoperation in all CABG patients irrespective of whether surgery was performed on- or off-pump.

Keywords

CABG: Clopidogrel Off-pump Reoperation Bleeding 
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Notes

Acknowledgments

This study was funded by AstraZeneca, LLP. The sponsor had no role in the design or conduct of the study, nor in the collection, management, analyses or interpretation of the data. AstraZeneca, LLP, was given the opportunity to review and comment on the final draft manuscript. The authors had full editorial independence and full responsibility for the final version of the manuscript.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Jeffrey S. Berger
    • 1
  • Peter M. Herout
    • 2
  • Qing Harshaw
    • 3
  • Steven R. Steinhubl
    • 4
  • Carla B. Frye
    • 3
  • Richard C. Becker
    • 5
  1. 1.New York University School of MedicineNew YorkUSA
  2. 2.Cardinal HealthWestmontUSA
  3. 3.EPI-Q, Inc.Oak BrookUSA
  4. 4.Geisinger Health SystemDanvilleUSA
  5. 5.Duke University Medical CenterDurhamUSA

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