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J Thorac Cardiovasc Surg 2007;134:59-64
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery

Jae Kwang Shim, MDa, Yong Seon Choi, MDa, Young Jun Oh, MDa,b, Sou Ouk Bang, MDa,b, Kyung Jong Yoo, MD, PhDc,d, Young Lan Kwak, MD, PhDa,b,d,*

a Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
b Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
c Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea.
d Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.

Received for publication November 17, 2006; revisions received March 2, 2007; accepted for publication March 15, 2007.

* Address for reprints: Young Lan Kwak, MD, PhD, Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Ku, Seoul, South Korea, 120-725. (Email: ylkwak{at}yumc.yonsei.ac.kr).

Objective: Preoperative exposure to clopidogrel and aspirin significantly increases postoperative bleeding in patients undergoing on-pump coronary artery bypass graft surgery. Off-pump coronary bypass grafting has been proposed as an alternative technique to attenuate postoperative bleeding associated with clopidogrel. This study aimed to determine the effects of aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in off-pump coronary artery bypass grafting.

Methods: One hundred six patients scheduled for off-pump coronary artery bypass grafting were divided into three groups: aspirin and clopidogrel discontinued more than 6 days before surgery (group 1, n = 35), aspirin and clopidogrel continued until 3 to 5 days before surgery (group 2, n = 51), and both medications continued within 2 days of surgery (group 3, n = 20). Thromboelastographic tracings were analyzed before induction of anesthesia. Routine coagulation profiles were measured before and after surgery. A cell salvage device was used during surgery and salvaged blood was reinfused. Chest tube drainage and blood transfusion requirement were recorded postoperatively.

Results: Patient characteristics, operative data, and thromboelastographic tracings were similar among the groups. There were significant decreases in hematocrit level and platelet count and prolongation in prothrombin time postoperatively in all groups without any intergroup differences. The amounts of perioperative blood loss and blood transfusion required were all similar among the groups.

Conclusion: Preoperative clopidogrel and aspirin exposure even within 2 days of surgery does not increase perioperative blood loss and blood transfusion requirements in patients undergoing elective off-pump coronary artery bypass grafting.

Abbreviations and Acronyms aPTT = activated partial thromboplastin time; CABG = coronary artery bypass graft; FFP = fresh frozen plasma; ICU = intensive care unit; MI = myocardial infarction; pRBCs = packed red blood cells; PT = prothrombin time; SD = standard deviation




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