Optimal Anticoagulation during Off Pump Coronary Artery Bypass in Patients Recently Exposed to Clopidogrel.
10.3349/ymj.2013.54.5.1119
- Author:
Young SONG
1
;
Jong Wook SONG
;
Jae Kwang SHIM
;
Young Lan KWAK
Author Information
1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. ylkwak@yuhs.ac
- Publication Type:Original Article
- Keywords:
Clopidogrel;
heparin;
time weighted average activated clotting time;
off-pump coronary artery bypass surgery
- MeSH:
Age Factors;
Aged;
Anastomosis, Surgical;
Blood Loss, Surgical/prevention & control;
Blood Transfusion;
*Coronary Artery Bypass, Off-Pump;
Female;
Heparin/administration & dosage/therapeutic use;
Humans;
Intraoperative Complications;
Male;
Middle Aged;
Multivariate Analysis;
Myocardial Infarction/etiology/prevention & control;
Perioperative Period;
Platelet Aggregation Inhibitors/administration & dosage/*therapeutic use;
Premedication;
Reference Values;
Retrospective Studies;
Sex Factors;
Ticlopidine/administration & dosage/*analogs & derivatives/therapeutic use;
Whole Blood Coagulation Time
- From:Yonsei Medical Journal
2013;54(5):1119-1126
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The aim of this study was to find an optimal range of activated clotting time (ACT) during off-pump coronary artery bypass surgery (OPCAB) yielding ischemic protection without the risk of hemorrhagic complications in patients with recent exposure to dual antiplatelet therapy. MATERIALS AND METHODS: Three hundred and five patients who received aspirin and clopidogrel within 7 days of isolated multi-vessel OPCAB were retrospectively studied. Combined hemorrhagic and ischemic outcome was defined as the occurrence of 1 of the following: significant perioperative bleeding (>30% of estimated blood volume), transfusion of packed red blood cell (pRBC) > or =2 U, or myocardial infarction (MI). This was compared in relation to the tertile distribution of the time-weighted average ACT-212-291 sec (first tertile), 292-334 sec (second tertile), 335-485 sec (third tertile). RESULTS: The amount of perioperative blood loss was 937+/-313 mL, 1014+/-340 mL, and 1076+/-383 mL, respectively (p=0.022). Significantly more patients in the third tertile developed MI (4%, 4%, and 12%, respectively, p=0.034). The incidence of significant perioperative blood loss and transfusion of pRBC > or =2 U were lower in the first tertile than those of other tertiles without statistical significance. In the multivariate analysis, the first tertile was associated with a 52% risk reduction of combined hemorrhagic and ischemic outcomes (95% confidence interval: 0.25-0.92, p=0.027). CONCLUSION: A lower degree of anticoagulation with a reduced initial heparin loading dose should be carefully considered for patients undergoing OPCAB who have recently been exposed to clopidogrel.
