Optimal anticoagulation during off pump coronary artery bypass in patients recently exposed to clopidogrel

Young Song, Jong Wook Song, Jae Kwang Shim, Younglan Kwak

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: The aim of this study was to find an optimal range of activated clotting time (ACT) during off-pump coronary artery bypass surgery (OPCAB) yielding ischemic protection without the risk of hemorrhagic complications in patients with recent exposure to dual antiplatelet therapy. Materials and Methods: Three hundred and five patients who received aspirin and clopidogrel within 7 days of isolated multi-vessel OPCAB were retrospectively studied. Combined hemorrhagic and ischemic outcome was defined as the occurrence of 1 of the following: significant perioperative bleeding (>30% of estimated blood volume), transfusion of packed red blood cell (pRBC) ≥2 U, or myocardial infarction (MI). This was compared in relation to the tertile distribution of the time-weighted average ACT-212-291 sec (first tertile), 292-334 sec (second tertile), 335-485 sec (third tertile). Results: The amount of perioperative blood loss was 937±313 mL, 1014±340 mL, and 1076± 383 mL, respectively (p=0.022). Significantly more patients in the third tertile developed MI (4%, 4%, and 12%, respectively, p=0.034). The incidence of significant perioperative blood loss and transfusion of pRBC ≥2 U were lower in the first tertile than those of other tertiles without statistical significance. In the multivariate analysis, the first tertile was associated with a 52% risk reduction of combined hemorrhagic and ischemic outcomes (95% confidence interval: 0.25-0.92, p= 0.027). Conclusion: A lower degree of anticoagulation with a reduced initial heparin loading dose should be carefully considered for patients undergoing OPCAB who have recently been exposed to clopidogrel.

Original languageEnglish
Pages (from-to)1119-1126
Number of pages8
JournalYonsei medical journal
Volume54
Issue number5
DOIs
Publication statusPublished - 2013 Sep 1

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clopidogrel
Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Blood Transfusion
Erythrocytes
Myocardial Infarction
Risk Reduction Behavior
Blood Volume
Aspirin
Heparin
Multivariate Analysis
Confidence Intervals
Hemorrhage
Incidence

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

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title = "Optimal anticoagulation during off pump coronary artery bypass in patients recently exposed to clopidogrel",
abstract = "Purpose: The aim of this study was to find an optimal range of activated clotting time (ACT) during off-pump coronary artery bypass surgery (OPCAB) yielding ischemic protection without the risk of hemorrhagic complications in patients with recent exposure to dual antiplatelet therapy. Materials and Methods: Three hundred and five patients who received aspirin and clopidogrel within 7 days of isolated multi-vessel OPCAB were retrospectively studied. Combined hemorrhagic and ischemic outcome was defined as the occurrence of 1 of the following: significant perioperative bleeding (>30{\%} of estimated blood volume), transfusion of packed red blood cell (pRBC) ≥2 U, or myocardial infarction (MI). This was compared in relation to the tertile distribution of the time-weighted average ACT-212-291 sec (first tertile), 292-334 sec (second tertile), 335-485 sec (third tertile). Results: The amount of perioperative blood loss was 937±313 mL, 1014±340 mL, and 1076± 383 mL, respectively (p=0.022). Significantly more patients in the third tertile developed MI (4{\%}, 4{\%}, and 12{\%}, respectively, p=0.034). The incidence of significant perioperative blood loss and transfusion of pRBC ≥2 U were lower in the first tertile than those of other tertiles without statistical significance. In the multivariate analysis, the first tertile was associated with a 52{\%} risk reduction of combined hemorrhagic and ischemic outcomes (95{\%} confidence interval: 0.25-0.92, p= 0.027). Conclusion: A lower degree of anticoagulation with a reduced initial heparin loading dose should be carefully considered for patients undergoing OPCAB who have recently been exposed to clopidogrel.",
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Optimal anticoagulation during off pump coronary artery bypass in patients recently exposed to clopidogrel. / Song, Young; Song, Jong Wook; Shim, Jae Kwang; Kwak, Younglan.

In: Yonsei medical journal, Vol. 54, No. 5, 01.09.2013, p. 1119-1126.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Optimal anticoagulation during off pump coronary artery bypass in patients recently exposed to clopidogrel

AU - Song, Young

AU - Song, Jong Wook

AU - Shim, Jae Kwang

AU - Kwak, Younglan

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Purpose: The aim of this study was to find an optimal range of activated clotting time (ACT) during off-pump coronary artery bypass surgery (OPCAB) yielding ischemic protection without the risk of hemorrhagic complications in patients with recent exposure to dual antiplatelet therapy. Materials and Methods: Three hundred and five patients who received aspirin and clopidogrel within 7 days of isolated multi-vessel OPCAB were retrospectively studied. Combined hemorrhagic and ischemic outcome was defined as the occurrence of 1 of the following: significant perioperative bleeding (>30% of estimated blood volume), transfusion of packed red blood cell (pRBC) ≥2 U, or myocardial infarction (MI). This was compared in relation to the tertile distribution of the time-weighted average ACT-212-291 sec (first tertile), 292-334 sec (second tertile), 335-485 sec (third tertile). Results: The amount of perioperative blood loss was 937±313 mL, 1014±340 mL, and 1076± 383 mL, respectively (p=0.022). Significantly more patients in the third tertile developed MI (4%, 4%, and 12%, respectively, p=0.034). The incidence of significant perioperative blood loss and transfusion of pRBC ≥2 U were lower in the first tertile than those of other tertiles without statistical significance. In the multivariate analysis, the first tertile was associated with a 52% risk reduction of combined hemorrhagic and ischemic outcomes (95% confidence interval: 0.25-0.92, p= 0.027). Conclusion: A lower degree of anticoagulation with a reduced initial heparin loading dose should be carefully considered for patients undergoing OPCAB who have recently been exposed to clopidogrel.

AB - Purpose: The aim of this study was to find an optimal range of activated clotting time (ACT) during off-pump coronary artery bypass surgery (OPCAB) yielding ischemic protection without the risk of hemorrhagic complications in patients with recent exposure to dual antiplatelet therapy. Materials and Methods: Three hundred and five patients who received aspirin and clopidogrel within 7 days of isolated multi-vessel OPCAB were retrospectively studied. Combined hemorrhagic and ischemic outcome was defined as the occurrence of 1 of the following: significant perioperative bleeding (>30% of estimated blood volume), transfusion of packed red blood cell (pRBC) ≥2 U, or myocardial infarction (MI). This was compared in relation to the tertile distribution of the time-weighted average ACT-212-291 sec (first tertile), 292-334 sec (second tertile), 335-485 sec (third tertile). Results: The amount of perioperative blood loss was 937±313 mL, 1014±340 mL, and 1076± 383 mL, respectively (p=0.022). Significantly more patients in the third tertile developed MI (4%, 4%, and 12%, respectively, p=0.034). The incidence of significant perioperative blood loss and transfusion of pRBC ≥2 U were lower in the first tertile than those of other tertiles without statistical significance. In the multivariate analysis, the first tertile was associated with a 52% risk reduction of combined hemorrhagic and ischemic outcomes (95% confidence interval: 0.25-0.92, p= 0.027). Conclusion: A lower degree of anticoagulation with a reduced initial heparin loading dose should be carefully considered for patients undergoing OPCAB who have recently been exposed to clopidogrel.

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