Effect of anti-platelet therapy on peri-operative blood loss in patients undergoing off-pump coronary artery bypass grafting

• Published in: Annals of cardiac anaesthesia Vol. 25; no. 2; pp. 182 - 187
• Main Authors: Kapoor, Samir, Singh, Gurmeet, Arya, Rajesh, Singh, Vikrampal, Garg, Arun, Ralhan, Sarju, Gupta, Vivek, Mohan, Bishav, Wander, Gurpreet, Gupta, Rajiv
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.04.2022; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: anti-platelet; Aspirin; Aspirin - therapeutic use; Biological products; Blood Loss, Surgical - prevention & control; Blood products; blood transfusion; Clopidogrel; Clopidogrel - therapeutic use; Coronary artery bypass; Coronary Artery Bypass - adverse effects; Coronary vessels; Heart surgery; Humans; Medical research; Medicine, Experimental; off-pump cabg; Original; Platelet Aggregation Inhibitors - therapeutic use; post-operative bleeding; Postoperative Hemorrhage - drug therapy; Retrospective Studies; Surgery; Ticlopidine - therapeutic use; clopidogrel; blood transfusion; aspirin; post-operative bleeding; Anti-platelet; off-pump CABG
• ISSN: 0971-9784; 0974-5181
• DOI: 10.4103/aca.aca_12_22

Purpose: The purpose of this study was to review the effect of the pre-operative use of clopidogrel and aspirin on peri-operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG). Materials and Methods: A total of 1200 patients who underwent off-pump CABG (OPCABG) between 2010 and 2012 were retrospectively studied. Patients were divided into three groups: group 1: discontinued aspirin and clopidogrel 6 days prior to surgery (n = 468), group 2: discontinued both drugs 3 to 5 days prior to surgery (n = 621), and group 3: discontinued both drugs 2 days prior to surgery (n = 111). The bleeding pattern and blood product transfusion were studied and compared between the groups. Patients having history of other drugs affecting the coagulation profile, other organ dysfunction, on-pump CABG, and the combined procedure were excluded from the study. Results: Group 2 patients had a higher rate of bleeding and a reduced mean value of hemoglobin (Hb) as compared to other groups. The same results were seen in blood and blood product transfusion. Patients of group 2 and group 3 were associated with higher blood loss in terms of drainage at 12 and 24 hours. Post-operatively, this was statistically significant. Re-exploration was statisitically significant in group 3 patients (9.01%) than in group 2 (2.58%) and group 1 (1.07%) patients. Conclusion: The pre-operative use of clopidogrel and aspirin in patients undergoing OPCABG showed limited clinical benefits; however, its use significantly increased the risk of bleeding and blood transfusion, thus increasing morbidity and resource utilization. Hence, clopidogrel and aspirin should be stopped at least 6 days prior to surgery.