Effect of anti-platelet therapy on peri-operative blood loss in patients undergoing off-pump coronary artery bypass grafting
Purpose: The purpose of this study was to review the effect of the pre-operative use of clopidogrel and aspirin on peri-operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG). Materials and Methods: A total of 1200 patients who underwent...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Annals of Cardiac Anaesthesia |
| Subjects: | |
| Online Access: | http://www.annals.in/article.asp?issn=0971-9784;year=2022;volume=25;issue=2;spage=182;epage=187;aulast=Kapoor |
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| author | Samir Kapoor Gurmeet Singh Rajesh Chand Arya Vikrampal Singh Arun Garg Sarju Ralhan Vivek Kumar Gupta Bishav Mohan Gurpreet Singh Wander Rajiv Kumar Gupta |
| author_facet | Samir Kapoor Gurmeet Singh Rajesh Chand Arya Vikrampal Singh Arun Garg Sarju Ralhan Vivek Kumar Gupta Bishav Mohan Gurpreet Singh Wander Rajiv Kumar Gupta |
| author_sort | Samir Kapoor |
| collection | DOAJ |
| description | Purpose: The purpose of this study was to review the effect of the pre-operative use of clopidogrel and aspirin on peri-operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG).
Materials and Methods: A total of 1200 patients who underwent off-pump CABG (OPCABG) between 2010 and 2012 were retrospectively studied. Patients were divided into three groups: group 1: discontinued aspirin and clopidogrel 6 days prior to surgery (n = 468), group 2: discontinued both drugs 3 to 5 days prior to surgery (n = 621), and group 3: discontinued both drugs 2 days prior to surgery (n = 111). The bleeding pattern and blood product transfusion were studied and compared between the groups. Patients having history of other drugs affecting the coagulation profile, other organ dysfunction, on-pump CABG, and the combined procedure were excluded from the study.
Results: Group 2 patients had a higher rate of bleeding and a reduced mean value of hemoglobin (Hb) as compared to other groups. The same results were seen in blood and blood product transfusion. Patients of group 2 and group 3 were associated with higher blood loss in terms of drainage at 12 and 24 hours. Post-operatively, this was statistically significant. Re-exploration was statisitically significant in group 3 patients (9.01%) than in group 2 (2.58%) and group 1 (1.07%) patients.
Conclusion: The pre-operative use of clopidogrel and aspirin in patients undergoing OPCABG showed limited clinical benefits; however, its use significantly increased the risk of bleeding and blood transfusion, thus increasing morbidity and resource utilization. Hence, clopidogrel and aspirin should be stopped at least 6 days prior to surgery. |
| first_indexed | 2024-04-14T05:49:28Z |
| format | Article |
| id | doaj.art-5a81aa0d73c94f3097de492302d7c57c |
| institution | Directory Open Access Journal |
| issn | 0971-9784 |
| language | English |
| last_indexed | 2024-04-14T05:49:28Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Cardiac Anaesthesia |
| spelling | doaj.art-5a81aa0d73c94f3097de492302d7c57c2022-12-22T02:09:10ZengWolters Kluwer Medknow PublicationsAnnals of Cardiac Anaesthesia0971-97842022-01-0125218218710.4103/aca.aca_12_22Effect of anti-platelet therapy on peri-operative blood loss in patients undergoing off-pump coronary artery bypass graftingSamir KapoorGurmeet SinghRajesh Chand AryaVikrampal SinghArun GargSarju RalhanVivek Kumar GuptaBishav MohanGurpreet Singh WanderRajiv Kumar GuptaPurpose: The purpose of this study was to review the effect of the pre-operative use of clopidogrel and aspirin on peri-operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG). Materials and Methods: A total of 1200 patients who underwent off-pump CABG (OPCABG) between 2010 and 2012 were retrospectively studied. Patients were divided into three groups: group 1: discontinued aspirin and clopidogrel 6 days prior to surgery (n = 468), group 2: discontinued both drugs 3 to 5 days prior to surgery (n = 621), and group 3: discontinued both drugs 2 days prior to surgery (n = 111). The bleeding pattern and blood product transfusion were studied and compared between the groups. Patients having history of other drugs affecting the coagulation profile, other organ dysfunction, on-pump CABG, and the combined procedure were excluded from the study. Results: Group 2 patients had a higher rate of bleeding and a reduced mean value of hemoglobin (Hb) as compared to other groups. The same results were seen in blood and blood product transfusion. Patients of group 2 and group 3 were associated with higher blood loss in terms of drainage at 12 and 24 hours. Post-operatively, this was statistically significant. Re-exploration was statisitically significant in group 3 patients (9.01%) than in group 2 (2.58%) and group 1 (1.07%) patients. Conclusion: The pre-operative use of clopidogrel and aspirin in patients undergoing OPCABG showed limited clinical benefits; however, its use significantly increased the risk of bleeding and blood transfusion, thus increasing morbidity and resource utilization. Hence, clopidogrel and aspirin should be stopped at least 6 days prior to surgery.http://www.annals.in/article.asp?issn=0971-9784;year=2022;volume=25;issue=2;spage=182;epage=187;aulast=Kapooranti-plateletaspirinblood transfusionclopidogreloff-pump cabgpost-operative bleeding |
| spellingShingle | Samir Kapoor Gurmeet Singh Rajesh Chand Arya Vikrampal Singh Arun Garg Sarju Ralhan Vivek Kumar Gupta Bishav Mohan Gurpreet Singh Wander Rajiv Kumar Gupta Effect of anti-platelet therapy on peri-operative blood loss in patients undergoing off-pump coronary artery bypass grafting Annals of Cardiac Anaesthesia anti-platelet aspirin blood transfusion clopidogrel off-pump cabg post-operative bleeding |
| title | Effect of anti-platelet therapy on peri-operative blood loss in patients undergoing off-pump coronary artery bypass grafting |
| title_full | Effect of anti-platelet therapy on peri-operative blood loss in patients undergoing off-pump coronary artery bypass grafting |
| title_fullStr | Effect of anti-platelet therapy on peri-operative blood loss in patients undergoing off-pump coronary artery bypass grafting |
| title_full_unstemmed | Effect of anti-platelet therapy on peri-operative blood loss in patients undergoing off-pump coronary artery bypass grafting |
| title_short | Effect of anti-platelet therapy on peri-operative blood loss in patients undergoing off-pump coronary artery bypass grafting |
| title_sort | effect of anti platelet therapy on peri operative blood loss in patients undergoing off pump coronary artery bypass grafting |
| topic | anti-platelet aspirin blood transfusion clopidogrel off-pump cabg post-operative bleeding |
| url | http://www.annals.in/article.asp?issn=0971-9784;year=2022;volume=25;issue=2;spage=182;epage=187;aulast=Kapoor |
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