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Clopidogrel responsiveness regardless of the discontinuation date predicts increased blood loss and transfusion requirement after off-pump coronary artery bypass graft surgery

Authors
 Young-Lan Kwak  ;  Jong-Chan Kim  ;  Yong-Seon Choi  ;  Kyung-Jong Yoo  ;  Young Song  ;  Jae-Kwang Shim 
Citation
 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol.56(24) : 1994-2002, 2010 
Journal Title
 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 
ISSN
 0735-1097 
Issue Date
2010
MeSH
Aged ; Blood Loss, Surgical* ; Blood Platelets/drug effects* ; Blood Transfusion ; Coronary Artery Bypass, Off-Pump* ; Female ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/pharmacology* ; Prospective Studies ; Thrombelastography ; Ticlopidine/analogs & derivatives* ; Ticlopidine/pharmacology
Keywords
clopidogrel ; coronary artery bypass surgery ; off-pump ; transfusion
Abstract
OBJECTIVES: the purpose of this study was to evaluate the association of the percentage of platelet inhibitory response to clopidogrel as assessed by modified thromboelastography with bleeding and transfusion requirement after off-pump coronary artery bypass graft (OPCABG) surgery. BACKGROUND: Interindividual variability of clopidogrel responsiveness may influence bleeding and transfusion requirement. METHODS: one hundred patients who received clopidogrel within 5 days of OPCABG were prospectively enrolled. The primary end point was to compare post-operative bleeding and transfusion requirement in relation to the tertile distribution of the percentage of platelet inhibitory response to clopidogrel. RESULTS: blood loss in the patients in the third tertile was 914 ± 264 ml compared with 623 ± 249 ml in those in the first and 683 ± 254 ml in those in the second tertiles (p = 0.001). Significantly more patients in the third tertile were transfused, and the number of units transfused was also larger. On multivariate analysis, the third tertile was associated with an 11-fold increased risk of transfusion (95% confidence interval: 2.77 to 47.30, p = 0.001). The optimal cutoff value for the transfusion requirement measured by receiver-operator characteristic curve analysis was 70% platelet inhibitory response to clopidogrel (area under the curve: 0.771; 95% confidence interval: 0.674 to 0.868; p < 0.001). CONCLUSIONS: a high percentage of platelet inhibitory response to clopidogrel, regardless of the proximity of clopidogrel exposure, predicts increased blood loss and transfusion requirement after OPCABG with a cutoff value of 70% for increased risk of transfusion. These findings might implicate a potential role of modified thromboelastography in deciding the timing of OPCABG in patients who need continued clopidogrel therapy
Full Text
http://www.sciencedirect.com/science/article/pii/S0735109710040520
DOI
10.1016/j.jacc.2010.03.108
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Kim, Jong Chan(김종찬)
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/102433
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