Clopidogrel Does Not Increase Bleeding and Allogenic Blood Transfusion Before Coronary Artery Surgery

Platelet dysfunction is one of the major reasons of postoperative bleeding following coronary artery surgery. The aim of this study was to evaluate the effects of clopidogrel, a specific and potent irreversible inhibitor of platelet aggregation, on bleeding and use of blood and blood products after coronary artery bypass surgery. We studied 1628 consecutive patients who underwent isolated coronary artery bypass grafting, and compared those with preoperative clopidogrel exposure prior to the operation (n=48) to those without exposure (n=1580). All operations were performed by the same surgical and anesthesia team. The clopidogrel group had higher prothrombin time level (12.6 ± 1.6; 11.5 ± 1.7 sec, p=0.013), however comparable APTT level (32.6±4.5 vs. 31.4±4.5 sec), platelet count (275.000±98.000 vs. 280.000±72.000 /dL), number of distal anastomosis (2.6±1.1 vs. 2.8±1.1), cardiopulmonary bypass time (55±26 vs. 63±25 min), total chest tube output (719±265 vs. 612±350 ml), reoperation for bleeding (%0 vs. %1); red blood cell transfusion (0.5±0.9 vs. 0.4±0.9 U/patient), use of fresh frozen plasma (1.1±1.2 vs. 0.9±1.1 U/patient) , intensive care unit length of stay (20.1± 2.9 vs. 21.9±13.5 hr), and length of hospital stay (5.5±1.7 vs. 5.4±2.1 days). The results of this study suggest that preoperative use of clopidogrel is not associated with increased bleeding and need for surgical exploration as well as risk of blood and blood product transfusion after coronary artery bypass surgery.