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Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel

BACKGROUND: The administration of antiplatelet drugs before coronary artery bypass graft surgery (CABG) is associated with an increased risk of major hemorrhage and related surgical reexploration. Little is known about the relative effect of combined clopidogrel and aspirin on blood product use arou...

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Autores principales: Ray, Joel G, Deniz, Stacy, Olivieri, Anthony, Pollex, Erika, Vermeulen, Marian J, Alexander, Kurian S, Cain, David J, Cybulsky, Irene, Hamielec, Cindy M
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2003
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC162165/
https://www.ncbi.nlm.nih.gov/pubmed/12769833
http://dx.doi.org/10.1186/1471-2261-3-3
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author Ray, Joel G
Deniz, Stacy
Olivieri, Anthony
Pollex, Erika
Vermeulen, Marian J
Alexander, Kurian S
Cain, David J
Cybulsky, Irene
Hamielec, Cindy M
author_facet Ray, Joel G
Deniz, Stacy
Olivieri, Anthony
Pollex, Erika
Vermeulen, Marian J
Alexander, Kurian S
Cain, David J
Cybulsky, Irene
Hamielec, Cindy M
author_sort Ray, Joel G
collection PubMed
description BACKGROUND: The administration of antiplatelet drugs before coronary artery bypass graft surgery (CABG) is associated with an increased risk of major hemorrhage and related surgical reexploration. Little is known about the relative effect of combined clopidogrel and aspirin on blood product use around the time of CABG. We evaluated the associated risk between the combined use of aspirin and clopidogrel and the transfusion of blood products perioperatively. METHODS: We retrospectively studied a cohort of 659 individuals who underwent a first CABG, without concomitant valvular or aortic surgery, at a single large Canadian cardiac surgical centre between January 2000 and April 2002. The four study exposure groups were those prescribed aspirin (n = 105), clopidogrel (n = 11), the combination of both (n = 46), or neither drug (n = 497), within 7 days prior to CABG. The primary study outcome was the excessive transfusion of blood products during CABG and up to the second post-operative day, defined as ≥ 2 units of packed red blood cells (PRBC), ≥ 2 units of fresh frozen plasma, ≥ 5 units of cryoprecipitate or ≥ 5 units of platelets. Secondary outcomes included the mean number of transfused units of each type of blood product. RESULTS: A greater mean number of units of PRBC were transfused among those who received clopidogrel alone (2.9) or in combination with aspirin (2.4), compared to those on aspirin alone (1.9) or neither antiplatelet drug (1.4) (P = 0.001). A similar trend was seen for the respective mean number of transfused units of platelets (3.6, 3.7, 1.3 and 1.0; P < 0.001) and fresh frozen plasma (2.5, 3.1, 2.3, 1.6; P = 0.01). Compared to non-users, the associated risk of excessive blood product transfusion was highest among recipients of aspirin and clopidogrel together (adjusted OR 2.2, 95% CI 1.1–4.3). No significant association was seen among lone users of aspirin (adjusted OR 1.0, 95% CI 0.6–1.6) or clopidogrel (adjusted OR 0.7, 95% CI 0.2–2.5), compared to non-users. CONCLUSIONS: While combined use of aspirin and clopidogrel shortly before CABG surgery may increase the associated risk of excess transfusion of blood products perioperatively, several study limitations prevent any confident conclusions from being drawn. Beyond challenging these findings, future research might focus on the value of both intraoperative monitoring of platelet function, and the effectiveness of antifibrinolytic agents, at reducing the risk of postoperative bleeding.
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spelling pubmed-1621652003-06-25 Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel Ray, Joel G Deniz, Stacy Olivieri, Anthony Pollex, Erika Vermeulen, Marian J Alexander, Kurian S Cain, David J Cybulsky, Irene Hamielec, Cindy M BMC Cardiovasc Disord Research Article BACKGROUND: The administration of antiplatelet drugs before coronary artery bypass graft surgery (CABG) is associated with an increased risk of major hemorrhage and related surgical reexploration. Little is known about the relative effect of combined clopidogrel and aspirin on blood product use around the time of CABG. We evaluated the associated risk between the combined use of aspirin and clopidogrel and the transfusion of blood products perioperatively. METHODS: We retrospectively studied a cohort of 659 individuals who underwent a first CABG, without concomitant valvular or aortic surgery, at a single large Canadian cardiac surgical centre between January 2000 and April 2002. The four study exposure groups were those prescribed aspirin (n = 105), clopidogrel (n = 11), the combination of both (n = 46), or neither drug (n = 497), within 7 days prior to CABG. The primary study outcome was the excessive transfusion of blood products during CABG and up to the second post-operative day, defined as ≥ 2 units of packed red blood cells (PRBC), ≥ 2 units of fresh frozen plasma, ≥ 5 units of cryoprecipitate or ≥ 5 units of platelets. Secondary outcomes included the mean number of transfused units of each type of blood product. RESULTS: A greater mean number of units of PRBC were transfused among those who received clopidogrel alone (2.9) or in combination with aspirin (2.4), compared to those on aspirin alone (1.9) or neither antiplatelet drug (1.4) (P = 0.001). A similar trend was seen for the respective mean number of transfused units of platelets (3.6, 3.7, 1.3 and 1.0; P < 0.001) and fresh frozen plasma (2.5, 3.1, 2.3, 1.6; P = 0.01). Compared to non-users, the associated risk of excessive blood product transfusion was highest among recipients of aspirin and clopidogrel together (adjusted OR 2.2, 95% CI 1.1–4.3). No significant association was seen among lone users of aspirin (adjusted OR 1.0, 95% CI 0.6–1.6) or clopidogrel (adjusted OR 0.7, 95% CI 0.2–2.5), compared to non-users. CONCLUSIONS: While combined use of aspirin and clopidogrel shortly before CABG surgery may increase the associated risk of excess transfusion of blood products perioperatively, several study limitations prevent any confident conclusions from being drawn. Beyond challenging these findings, future research might focus on the value of both intraoperative monitoring of platelet function, and the effectiveness of antifibrinolytic agents, at reducing the risk of postoperative bleeding. BioMed Central 2003-05-22 /pmc/articles/PMC162165/ /pubmed/12769833 http://dx.doi.org/10.1186/1471-2261-3-3 Text en Copyright © 2003 Ray et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
spellingShingle Research Article
Ray, Joel G
Deniz, Stacy
Olivieri, Anthony
Pollex, Erika
Vermeulen, Marian J
Alexander, Kurian S
Cain, David J
Cybulsky, Irene
Hamielec, Cindy M
Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel
title Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel
title_full Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel
title_fullStr Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel
title_full_unstemmed Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel
title_short Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel
title_sort increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC162165/
https://www.ncbi.nlm.nih.gov/pubmed/12769833
http://dx.doi.org/10.1186/1471-2261-3-3
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