Abstract 289: Complete 5 Year Follow-up of Coronary Artery Bypass Graft Patients Treated With Clopidogrel
Objective: An increased number of patients undergoing OPCABG is preoperatively treated with irreversible platelet inhibitors such as Clopidogrel. The objective was to evaluate its impact on bleeding complications and mortality/morbidity and long-term survival.
Methods: We analyzed prospectively collected data of 761 consecutive OPCABG patients revasculated over two years. Aspirin (87%) and 139 (18.5%) did receive Clopidogrel prior to surgery. Within this group 74 (53.2%) patients did receive Aprotinin intraoperativly. All sternotomies, intra-op heparin for ACT>300s, protamin. T-test and Chi-2 showed no significant differences for baseline characteristics. Kaplan-Meier long-term outcome analysis.
Results: Clopidogrel was associated with a significant increase in perioperative blood loss (P=0.003) and more excessive postoperative hemorrhage (P=0.04). Overall transfusion rates (P=0.02) and the amount of administered blood products (P=0.01) were also higher after clopidogrel exposure. Intraoperative aprotinin reduced postoperative bleeding significantly in patients administered clopidogrel and attentuated excessive postoperative hemorrhaging. Stroke rate and myocardial infarction ranged from 0% and 1.5% to 1.7% and 2.4% and was lowest in the clopidogrel teated patients. Early mortality ranged from 3.1% to 4.7% (p=0.91). Total follow-up time consisted of 3118.7 patient-years with a mean follow-up of 49.7±16 months (range 0–66 months). No patient was lost to follow-up. Five-year survival was significantly improved in clopidogrel-treated patients (94% vs. 85%, p=0.02).
Conclusions: _ Preoperative clopidogrel exposure does increase perioperative blood loss and blood transfusion requirements in patients undergoing OPCABG but has an otherwise excellent safety profile with a 94% 5-year survival rate. Based on these results a recommendation to discontinue clopidogrel prior to coronary artery bypass grafting cannot be maintained,
- © 2010 by American Heart Association, Inc.