초록접수 현황
| 14F-121 | 구연 발표 |
Does Clopidogel Increase Postoperative Bleeding after Off-pump Coronary Artery Bypass Graft Surgery?
Suryeun Chung, Yoon-Cheol Shin, Dong Jung Kim, Jun Sung Kim, Cheong Lim, Kay-Hyun Park
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
Background : As clopidogrel became an important part of managing patients developing acute coronary syndrome or undergoing percutaneous intervention, increasing number of patients under concurrent clopidogrel medication are presenting for CABG. This study aimed to determine the influence of clopidogrel on the postoperative course after off-pump CABG (OPCAB) including blood loss and transfusion requirement.
Methods : Data were retrospectively collected for the 550 patients who underwent isolated OPCAB between January 2003 and February 2014. Early postoperative outcome including chest tube drainage amount, need for blood transfusion, mortality, incidence of reoperation for bleeding, myocardial infarction and other major morbidities were compared between the following three groups; patients who did not take clopidogrel preoperatively (NO USE group, n=189; 133 of them on aspirin use), patients in whom clopidogrel was stopped 24 hours before surgery or earlier (PAST group, n=209), patients who were taking clopidogrel until the day before surgery (CONCURRENT, n=152).
Results : CONCURRENT group had a higher proportion of patients who experienced previous myocardial infarction, preoperative IABP, and urgent/emergent surgery (p<0.001). There was no difference in any of major parameters of postoperative outcome including bleeding complication and transfusion requirement (Table). In multivariate analysis looking at the factors associated with reoperation for bleeding or blood transfusion, concurrent or past use of clopidogrel was not a risk factor. The only significant risk factor for transfusion was emergent surgery (OR, 3.9; 95% CI, 0.98-15.7; p=0.05).
Conclusion : Preoperative use of clopidogrel even until the day before OPCAB did not increase the transfusion requirement and incidence of bleeding and other adverse outcomes. We do not recommend delaying CABG because of concurrent clopidogrel use, at least when off-pump surgery is planned.
Methods : Data were retrospectively collected for the 550 patients who underwent isolated OPCAB between January 2003 and February 2014. Early postoperative outcome including chest tube drainage amount, need for blood transfusion, mortality, incidence of reoperation for bleeding, myocardial infarction and other major morbidities were compared between the following three groups; patients who did not take clopidogrel preoperatively (NO USE group, n=189; 133 of them on aspirin use), patients in whom clopidogrel was stopped 24 hours before surgery or earlier (PAST group, n=209), patients who were taking clopidogrel until the day before surgery (CONCURRENT, n=152).
Results : CONCURRENT group had a higher proportion of patients who experienced previous myocardial infarction, preoperative IABP, and urgent/emergent surgery (p<0.001). There was no difference in any of major parameters of postoperative outcome including bleeding complication and transfusion requirement (Table). In multivariate analysis looking at the factors associated with reoperation for bleeding or blood transfusion, concurrent or past use of clopidogrel was not a risk factor. The only significant risk factor for transfusion was emergent surgery (OR, 3.9; 95% CI, 0.98-15.7; p=0.05).
Conclusion : Preoperative use of clopidogrel even until the day before OPCAB did not increase the transfusion requirement and incidence of bleeding and other adverse outcomes. We do not recommend delaying CABG because of concurrent clopidogrel use, at least when off-pump surgery is planned.
첨부파일 : Table[1].pptx
책임저자: Kay-Hyun Park
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
연락처 : Suryeun Chung, Tel: 031-787-7140 , E-mail : suryeun.chung@gmail.com
