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Optimal Anticoagulation during Off Pump Coronary Artery Bypass in Patients Recently Exposed to Clopidogrel

Authors
 Young Song  ;  Jong Wook Song  ;  Jae Kwang Shim  ;  Young Lan Kwak 
Citation
 YONSEI MEDICAL JOURNAL, Vol.54(5) : 1119-1126, 2013 
Journal Title
YONSEI MEDICAL JOURNAL
ISSN
 0513-5796 
Issue Date
2013
MeSH
Age Factors ; Aged ; Anastomosis, Surgical ; Blood Loss, Surgical/prevention & control ; Blood Transfusion ; Coronary Artery Bypass, Off-Pump* ; Female ; Heparin/administration & dosage ; Heparin/therapeutic use ; Humans ; Intraoperative Complications ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/etiology ; Myocardial Infarction/prevention & control ; Perioperative Period ; Platelet Aggregation Inhibitors/administration & dosage ; Platelet Aggregation Inhibitors/therapeutic use* ; Premedication ; Reference Values ; Retrospective Studies ; Sex Factors ; Ticlopidine/administration & dosage ; Ticlopidine/analogs & derivatives* ; Ticlopidine/therapeutic use ; Whole Blood Coagulation Time
Keywords
Clopidogrel ; heparin ; off-pump coronary artery bypass surgery ; time weighted average activated clotting time
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.
Files in This Item:
T201302449.pdf Download
DOI
10.3349/ymj.2013.54.5.1119
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Song, Young(송영) ORCID logo https://orcid.org/0000-0003-4597-387X
Song, Jong Wook(송종욱) ORCID logo https://orcid.org/0000-0001-7518-2070
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/87380
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