Caution of use clopidogrel (Plavix ®) in cardiac surgery

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


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.


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Hirose, H. (2006). Caution of use clopidogrel (Plavix ®) in cardiac surgery. Bulletin of the International Scientific Surgical Association, 1(3), 51-55. извлечено от
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