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Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery

BACKGROUND: Major societal guidelines recommend a 5-day stop interval before cardiac surgery for patients with acute coronary syndrome receiving clopidogrel. Yet, many such patients present with high acuity, generating surgeon inclination toward use of shorter stop intervals. Thus, this study aimed...

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Autores principales: Huo, Bright, Hirsch, Gregory M., Doucette, Steve, Herman, Christine R., Gainer, Ryan, Mokhtar, Ahmed T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767124/
https://www.ncbi.nlm.nih.gov/pubmed/35072023
http://dx.doi.org/10.1016/j.cjco.2021.08.006
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author Huo, Bright
Hirsch, Gregory M.
Doucette, Steve
Herman, Christine R.
Gainer, Ryan
Mokhtar, Ahmed T.
author_facet Huo, Bright
Hirsch, Gregory M.
Doucette, Steve
Herman, Christine R.
Gainer, Ryan
Mokhtar, Ahmed T.
author_sort Huo, Bright
collection PubMed
description BACKGROUND: Major societal guidelines recommend a 5-day stop interval before cardiac surgery for patients with acute coronary syndrome receiving clopidogrel. Yet, many such patients present with high acuity, generating surgeon inclination toward use of shorter stop intervals. Thus, this study aimed to determine the impact of the duration and timing of the interval of clopidogrel cessation on adverse bleeding events. METHODS: Patients who underwent cardiac surgery between 2009 and 2016 at a tertiary-care centre were included in this retrospective cohort study. Multivariable logistic regression models adjusted for clopidogrel stop interval, age, urgency of procedure, and procedure type were used to quantify the effect of clinically relevant baseline demographic characteristics on incidence of massive transfusion as well as hemorrhagic complication outcomes. RESULTS: A total of 5748 patients underwent cardiac surgery. In this cohort, 1743 patients (30.3%) received clopidogrel preoperatively, and 884 (50.7%) of these patients discontinued clopidogrel 5 days before presenting to the operating room. The administration of clopidogrel 1-2 days before surgery (odds ratio 1.97; 95% confidence interval: 1.18 to 3.29) was an independent predictor for massive transfusions and hemorrhagic complications (odds ratio 1.85; 95% confidence interval: 1.01 to 3.37). The 3-4 day group did not have an increased risk of major bleeding complications. The risk for both massive transfusions and hemorrhagic complications also increased with the urgency and complexity of surgery. CONCLUSION: A clopidogrel stop interval of 3-4 days preoperatively was not associated with an increased risk for major bleeding complications.
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spelling pubmed-87671242022-01-21 Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery Huo, Bright Hirsch, Gregory M. Doucette, Steve Herman, Christine R. Gainer, Ryan Mokhtar, Ahmed T. CJC Open Original Article BACKGROUND: Major societal guidelines recommend a 5-day stop interval before cardiac surgery for patients with acute coronary syndrome receiving clopidogrel. Yet, many such patients present with high acuity, generating surgeon inclination toward use of shorter stop intervals. Thus, this study aimed to determine the impact of the duration and timing of the interval of clopidogrel cessation on adverse bleeding events. METHODS: Patients who underwent cardiac surgery between 2009 and 2016 at a tertiary-care centre were included in this retrospective cohort study. Multivariable logistic regression models adjusted for clopidogrel stop interval, age, urgency of procedure, and procedure type were used to quantify the effect of clinically relevant baseline demographic characteristics on incidence of massive transfusion as well as hemorrhagic complication outcomes. RESULTS: A total of 5748 patients underwent cardiac surgery. In this cohort, 1743 patients (30.3%) received clopidogrel preoperatively, and 884 (50.7%) of these patients discontinued clopidogrel 5 days before presenting to the operating room. The administration of clopidogrel 1-2 days before surgery (odds ratio 1.97; 95% confidence interval: 1.18 to 3.29) was an independent predictor for massive transfusions and hemorrhagic complications (odds ratio 1.85; 95% confidence interval: 1.01 to 3.37). The 3-4 day group did not have an increased risk of major bleeding complications. The risk for both massive transfusions and hemorrhagic complications also increased with the urgency and complexity of surgery. CONCLUSION: A clopidogrel stop interval of 3-4 days preoperatively was not associated with an increased risk for major bleeding complications. Elsevier 2021-08-23 /pmc/articles/PMC8767124/ /pubmed/35072023 http://dx.doi.org/10.1016/j.cjco.2021.08.006 Text en Crown Copyright © 2021 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Huo, Bright
Hirsch, Gregory M.
Doucette, Steve
Herman, Christine R.
Gainer, Ryan
Mokhtar, Ahmed T.
Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery
title Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery
title_full Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery
title_fullStr Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery
title_full_unstemmed Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery
title_short Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery
title_sort impact of clopidogrel stop interval on major adverse bleeding events in cardiac surgery
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767124/
https://www.ncbi.nlm.nih.gov/pubmed/35072023
http://dx.doi.org/10.1016/j.cjco.2021.08.006
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