The Journal of Thoracic and Cardiovascular Surgery
Volume 134, Issue 1 , Pages 59-64 , July 2007

Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery

  • Jae Kwang Shim, MD

      Affiliations

    • Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
  • ,
  • Yong Seon Choi, MD

      Affiliations

    • Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
  • ,
  • Young Jun Oh, MD

      Affiliations

    • Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
    • Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
  • ,
  • Sou Ouk Bang, MD

      Affiliations

    • Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
    • Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
  • ,
  • Kyung Jong Yoo, MD, PhD

      Affiliations

    • Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea.
    • Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
  • ,
  • Young Lan Kwak, MD, PhD

      Affiliations

    • Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
    • Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
    • Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
    • Corresponding Author InformationAddress for reprints: Young Lan Kwak, MD, PhD, Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Ku, Seoul, South Korea, 120-725.

Received 17 November 2006 ,Revised 2 March 2007 ,Accepted 15 March 2007.

References 

  1. Kam PC, Nethery CM. The thienopyridine derivatives pharmacology and clinical developments. Anaesthesia. 2003;58:28–35
  2. Steinhubl SR, Berger PB, Mann JT, Fry ET, DeLago A, Wilmer C, et al. Early and sustained oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002;288:2411–2420
  3. CLASSICS investigators. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: the clopidogrel aspirin stent international cooperative study (CLASSICS). Circulation. 2000;102:624–629
  4. Muller C, Buttner HJ, Petersen J, Roskamm H. A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary-artery stents. Circulation. 2000;101:590–593
  5. CURE study investigators. The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial programme; rationale, design and baseline characteristics including a meta-analysis of the effects of thienopyridine in vascular disease. Eur Heart J. 2000;21:2033–2041
  6. CAPRIE steering committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1329–1339
  7. Hongo RH, Ley J, Dick SE, Yee RR. The effect of clopidogrel in combination with aspirin when given before coronary artery bypass grafting. J Am Coll Cardiol. 2002;40:231–237
  8. Yende S, Wunderink RG. Effect of clopidogrel on bleeding after coronary artery bypass surgery. Crit Care Med. 2001;29:2271–2275
  9. Kapetanakis EI, Medlam DA, Boyce SW, Haile E, Hill PC, Dullum MK, et al. Clopidogrel administration prior to coronary artery bypass grafting surgery: the cardiologist’s panacea or the surgeon’s headache. Eur Heart J. 2005;26:576–583
  10. Chu MW, Wilson SR, Novick RJ, Stitt LW, Quantz MA. Does clopidogrel increase blood loss following coronary artery bypass surgery?. Ann Thorac Surg. 2004;78:1536–1541
  11. Cannon CP, Mehta SR, Aranki SF. Balancing the benefit and risk of oral antiplatelet agents in coronary artery bypass surgery. Ann Thorac Surg. 2005;80:768–779
  12. Multicenter Study of Perioperative Ischemia Research Group. Aspirin and mortality from coronary bypass surgery. N Engl J Med. 2002;347:1309–1317
  13. Raja SG, Dreyfus GD. Impact of off-pump coronary artery bypass surgery on postoperative bleeding: current best available evidence. J Card Surg. 2006;21:35–41
  14. Karmanoukian H, Attuwabi B, Nader ND. Antithrombotic controversies in off-pump coronary bypass. Semin Thorac Cardiovasc Surg. 2005;17:59–65
  15. Frankel TL, Stamou SC, Lowery RC, Kapetanakis EI, Hill PC, Haile E, et al. Risk factors for hemorrhage-related reexploration and blood transfusion after conventional versus coronary revascularization without cardiopulmonary bypass. Eur J Cardiothorac Surg. 2005;27:494–500
  16. Kapetanakis EI, Medlam DA, Petro KR, Haile E, Hill PC, Dullum MK, et al. Effect of clopidogrel premedication in off-pump cardiac surgery: are we forfeiting the benefits of reduced hemorrhagic sequelae?. Circulation. 2006;113:1667–1674
  17. Woo YJ, Grand T, Valettas N. Off-pump coronary artery bypass grafting attenuates postoperative bleeding associated with preoperative clopidogrel administration. Heart Surg Forum. 2003;6:282–285
  18. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA guideline update for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction 2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). Circulation. 2002;106:1893–1900
  19. Gibbs NM, Weightman WM, Thackray NM, Michalopoulos N, Weidmann C. The effects of recent aspirin ingestion on platelet function in cardiac surgical patients. J Cardiothorac Vasc Anesth. 2001;15:55–59
  20. von Heymann C, Redlich U, Moritz M, Sander M, Vargas Hein O, Grubitzsch H, et al. Aspirin and clopidogrel taken until 2 days prior to coronary artery bypass graft surgery is associated with increased postoperative drainage loss. Thorac Cardiovasc Surg. 2005;53:341–345
  21. Wan IY, Arifi AA, Wan S, Yip JH, Sihoe AD, Thung KH, et al. Beating heart revascularization with or without cardiopulmonary bypass: evaluation of inflammatory response in a prospective randomized study. J Thorac Cardiovasc Surg. 2004;127:1624–1631
  22. Johansson-Synnergren M, Nilsson F, Bengtsson A, Jeppsson A, Wiklund L. Off-pump CABG reduces complement activation but does not significantly affect peripheral endothelial function: a prospective randomized study. Scand Cardiovasc J. 2004;38:53–58
  23. Bhatt DL, Chew DP, Hirsch AT, Ringleb PA, Hacke W, Topol EJ. Superiority of clopidogrel versus aspirin in patients with prior cardiac surgery. Circulation. 2001;103:363–368
  24. Fox KA, Mehta SR, Peters R, Zhao F, Lakkis N, Gersh BJ, et al. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non–ST-elevation acute coronary syndrome: the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) trial. Circulation. 2004;110:1202–1208
  25. Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494–502
  26. Mariani MA, Gu YJ, Boonstra PW, Grandjean JG, van Oeveren W, Ebels T. Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate?. Ann Thorac Surg. 1999;67:1370–1375

PII: S0022-5223(07)00545-4

doi: 10.1016/j.jtcvs.2007.03.013

The Journal of Thoracic and Cardiovascular Surgery
Volume 134, Issue 1 , Pages 59-64 , July 2007