Caution of use clopidogrel (Plavix ®) in cardiac surgery

  • H. Hirose Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA., USA

Аннотация

Introduction: Clopidogrel (Plavix ®) is the most potent and popular anti-platelet agent available in the United States and Europe. This medication has been primarily used for patients undergoing coronary stenting and well known to cardiologists; however, little knowledge has been share with cardiac surgeons in Japan. Thus, a literature search was performed to evaluate the risk of clopidogrel administration in patients undergoing coronary artery bypass grafting. Methods: Medline literature search was performed, focusing on the effect of clopidogrel against postoperative bleeding, transfusion and reoperation. A total of 9 papers were found and a total of4469 patients (503 patients in the clopidogrel group and 3966 patients in the control group) were pooled for analysis. Chi-square tests, Mantel Haenszel methods or general variance-based methods were utilized to calculate relative risk (RR) with 95% confidence limit (CL), as appropriate. Results: The clopidogrel group demonstrated 703 ml (95% CL 630-755 ml) more drainage than the control group. The transfusion rate was greater in the clopidogrel group: packed red blood cells (78% vs 46%, RR 3.96, 95% CL 2.98-5.27) , fresh frozen plasma (41% vs 15%, RR 4.19, 95% CL 3.06-5.76), and platelet (60% vs 12%, RR 11.63, 95% CL 8.35-16.19). The incidence of postoperative reexploration was also higher in the clopidogrel group than in the control group (8.2% vs 1.4%, Odds ratio 4.87, 95% CL 2.86-8.31), p<0.0001. Conclusion: The preoperative administration of clopidogrel increases postoperative coagulopathy-related complications. At least a 5-days interval after stopping clopidogrel is recommended to avoid clopidogrel-induced coagulopathy, otherwise the risk of bleeding should be carefully explained to the patients.

Литература

Aotiplatelet Traialists’ Collaborative overview of randomized trials of aotiplatelet therapy, I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994;308:81-106.

Taggart DP, Siddiqui A, Wheatley DJ. Low-dose preoperative aspirin therapy, postoperative blood loss, and transfusion requirements. Ann Thorac Surg 1990;50:424-428.

Sethi GK, Copeland JG, Goldman S, Moritz T, Zadioa K, Henderson WG. Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting. J Am Coll Cardiol 1990; 15:15-20.

Ferraris VA, Ferraris SP, Lough FC, Berry WR. Preoperative aspirin ingestion increase operative blood loss after coronary artery bypass grafting. Ann Thorac Surg 1988;45:71-74.

Rawitscher RE, Jones JW, McCoy TA, Liodsley DA. A prospective study of aspirin’s effect on red blood cell loss in cardiac surgery. J Cardiovasc Surg 1991;32:1-7.

Tumao KJ, McCarthy RJ, O’Coooor CJ, McCarthy WE, Ivankovich AD, Aspirin dose not increase allogenic blood transfusion in reoperative coronary artery bypass surgery. Aoesth Analg 1996;83:1178-1184.

Rich DL, Patel GC, Vela-Caotos F, Bodiao C, Laosmao S. Aspirin dose not increase homologous blood requirements in elective coronary bypass surgery. Anesth Analg 1994;79:4-8.

Dacey LJ, Munoz JJ, Johnson ER, et al for the Northern New England Cardiovascular Diseases Study Group. Effect of preoperative aspirin use on mortality in coronary artery bypass grafting patients. Ann Thorac Surg 2000;70:1986-1990.

Moses JW, Leon MB, Popma JJ, et al; SIRIUS Iovesti- gators. Sirolimus-eluting stents versus standard stents io patients with stenosis in a native coronary artery. N Engl J Med. 2003 2;349:1315-1323.

Kereiakes DJ, Choo JK, Young JJ, Broderick TM. Thrombosis and Drug-Eluting Stents: A Critical Appraisal. Rev Cardiovasc Med;2004;5:9-15.

Available from homepage of Japanese Association of Cardiovascular Catheterization Therapeutics (JACCT); http://www.jacct.com/des/top02.html.

Moloney BA. An analysis of the side-effects of ti- clopidine. In: Hass WK, Easton JD, eds. Ticlopidine, platelets and vascular disease,. New York: Sprioger- Verlag 1993:99-116.

Harker LA, Boissel JP, Pilgrim AJ, Gent M. Comparative safety and tolerability of clopidogrel and aspirin: results from CAPRIE. Clopidogrel versus aspirin in patients at risk of ischemic events. Drug Safety 1999;21:325-335.

Taniuchi M, Kurz HI, Lasala JM. Randomized comparison of ticlopidine and clopidogrel after intracoronary stent implantation in a broad patient population. Circulation 2001;104:539-543.

Bertrand ME, Rupprecht HJ, Urban P, Gershlick AH, for the CLASSICS Investigations. Double-blind study of the safety of clopidogrel with and without a loading does in combination with aspirin compared with ti- clopidine compared with ticlopidine in combination with aspirin after coronary stenting: the Clopidogrel Aspirin Stent International Cooperative Study (CLASSICS). Circulation 2000;102:624-629.

Muller C, Buttser HJ, Petersen J, Roskamm H. A rao- domized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary- artery stents. Circulation 2000;101:590-593.

Mishkel GJ, Aguirre FV, Ligoo RW, Rocha-Siogh KJ, Lucore CL. Clopidogrel as adjunctive antiplatelet therapy during coronary stenting. J Am Coll Cardiol 1999;34:1884-1889.

CAPRIE steering committee. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events. Lancet 1996;348:1-15.

Gerschutz GP, Bhatt DL. The CURE trial: using clopi- dogrel in acute coronary syndromes without ST- segmeot elevation. Cleve Clin J Med 2002;69:377-378.

Yusuf S, Zhao F, Mehta SR et al, The clopidogrel in unstable angina to prevent recurrent events trial investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndrome without ST- segment elevation. N Engl J Med 2001;345:495-502.

Yeode S, Wund^'ink R. Effect of clopidogrel OS bleeding after coronary artery bypass surgery. Crit Care Med 2001;29:2271-2275.

Hoogo RH, Ley J, Dick SE, Yee RR. The effect of clopidogrel in combination with aspirin when given before coronary artery bypass grafting. J Am Coll Cardiol 2002;40:231-237.

Chu MWA, Wilsoo SR, Novick RJ, Stitt LW, Quaotz MA. Does clopidogrel iocrease blood loss following coronary artery bypass surgery. Ann Thorac Surg 2004;78:1536-1341.

Eoglberger L, Faeh B, Berdat PA, Eberli F, Meier B, Carrel T. Impact of clopidogrel in coronary artery bypass grafting. Euro J Cardiothorac Surg 2004;26:96- 101.

Asciooe R, Ghosh A, Rogers CA, Coheo A, Mook C, Maogelioi CD. Io -hospital patients exposed to clopi- dogrel before coronary artery bypass graft surgery: a ward of caution. Ann Thorac Surg 2005;70:1210-1226.

Karabulut H, Toramao F, Evreokaya S, Goksel O, Ta- can S, Alhan C. Clopidogrel does not increase bleeding and allogenic blood transfusion in coronary artery surgery. Euro J Cardiothorac Surg 2004;25:419-423.

Chen L, Bracey AW, Radovaocevic R, et al. Clopido- grel and bleeding in patients undergoing elective coronary artery bypass grafting. J Thorac Cardiovasc Surg 2004;128:425-431.

Geoooi M, Tavakoli R, Hofer C, Bertel O, Turina M. Clopidogrel before urgent coronary artery bypass graft. J Thorac Cardiovasc Surg 2003;126:288-289.

Ray JG, Sdeoiz S, Olivieri A, et al. Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel. BMV Cardiovasc Dis 2003;3:3-8.

Bidstrup BP, Hunt BJ, Skeikh S, Parratt RN, Bidstrup JM, Sapsford RN. Amelioration of the bleediog teo- dency of preoperative aspirin after aortocoronary bypass grafting. Ann Thorac Surg 2000;69:541-547.

Weerasioghe A, Taylor KM. The platelet io cardiopulmonary bypass. Ann Thorac Surg 1998;66:2145-2152.

Herbert JM, Bemat A, Maffrand JP. Aprotioio reduces clopidogrel induced prolongation of the bleeding time in the rat. Thromb Res 1993;71:433-441.

Dacey LJ, Musoz JJ, Baribeau YR et al. Reexrloratios for hemorrhage following corosary artery bypass grafting: incidence asd risk factor. Northers New England Cardiovascular Disease Study Group. Arch Surg 1998;133:442-447.

Thabault JJ, et al. Sem Thromb Hemost 1999;25 (supple2):3-7.

Lim E, Corselisses J, Routledge T, КИ^Г S, Char- mas SC et al. Clopidogrel did sot inhibit platelet fusc- tion early after coronary artery bypass surgery: a prospective randomized trial. J Thorac Cardiovasc Surg 2004;128:432-435.
Опубликован
2006-05-31
Как цитировать
Hirose, H. (2006). Caution of use clopidogrel (Plavix ®) in cardiac surgery. Bulletin of the International Scientific Surgical Association, 1(3), 51-55. извлечено от http://surgjournal.ru/index.php/BISSA/article/view/118
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