Abstract 14394: Clopidogrel Administration Before Coronary Artery Bypass Grafting Increases Operative Mortality. A Meta-analysis On 29553 Patients
Background: Uncertainty remains regarding the risks and benefits related with clopidogrel (CL) administration prior coronary artery bypass grafting (CABG). We aimed to gain insights on the impact of CL usage prior CABG performing an updated meta-analysis on operative outcomes following CABG in patients receiving or not CL.
Methods and Results: Studies reporting comparative data were retrieved from Medline and the Cochrane database. Thirty-four comparative studies published throughout February 2010 of patients undergoing CABG while taking CL within 7 days before surgery or not were used. The study end points were operative blood loss, red blood cell transfusion requirements, reexploration, myocardial infarction and operative mortality rate. Random effects model and sensitivity analysis were used and heterogeneity between studies was assessed. A total of 29533 patients, of whom 6004 (20.3%) underwent cardiac surgery while taking CL before CABG, were analyzed. CL increased the risk of blood loss (weighted mean difference ,WMD 218 mL/24h; 95%CI 98–338; p<0.001), rate of transfusion (Odds ratio, OR 1.9; 95%CI 1.5–2.3; p<0.001), the number of blood unit transfused per patient (WMD 1.3 unit/p; 95%CI 0.9–1.7; p<0.001), re-exploration rate (OR 2.5;95%CI 1.9–3.7; p<0.001). A significant heterogeneity was found for these outcomes (I2=98% 82% 98% 40%). CL failed to reduce perioperative myocardial infarction rate (P=0.55) Operative mortality was higher for patients received CL (OR 1.49;95%CI 1.2–1.8; p<0.001) and sensitivity analysis revealed a significant effect of blood loss (p=0.004) and the number of blood units transfused (p=0.01) on operative mortality.
Conclusions: CL administration within 7 days from CABG was associated with a higher operative mortality and this was related to blood loss and transfusion requirement. CL did not confer any protection against perioperaive myocardial infarction. Therefore, CL should be omitted for 5–7 days prior CABG if clinical conditions allow.
- © 2010 by American Heart Association, Inc.