Optimal Duration for Clopidogrel Suspension prior to Cardiac Surgery
Muhammad Arslan Cheema1, Ali R. Ghani1, Waqas Ullah1, Asoka Balaratna2, Marc Cohen2. 1Internal Medicine, Abington Jefferson Health, Horsham, Rhode Island, United States, 2Cardiology, Abington Jefferson Health, Horsham, Pennsylvania, United States
Purpose of Study Recent American College of Cardiology (ACC) guideline suggests clopidogrel suspension five days before non-emergent cardiac surgery (Class IIa, Level B). This puts patients with recent angioplasty and ongoing ischemia at a high risk of stent thrombosis. We sought to determine the bleeding risk in patients who stopped clopidogrel at three or less than three days before cardiac surgery.
Methods Used A retrospective single center study was performed, and a total of 90 patients were included. Forty patients were not on clopidogrel and hence were used as a control group. Fifty of the remaining patients were randomized into two groups. Group A included patients who had clopidogrel stopped three or less than three days prior to the cardiac surgery and group B included patients who followed the standard ACC guidelines and clopidogrel was suspended five days before the coronary artery bypass graft (CABG). The frequency of the included patients in each group is shown in table 1. Postoperative hemoglobin drop was analyzed between subgroups using IBM SPSS version 22.
Summary of Results The mean age of the included population was 69.9 years (46-88) with 65% comprising of male and 35% female patients. The mean hemoglobin (Hb) drop for patients in group A was 2.42 in comparison with Hb drop of 2.51 for patients in group B prior to the surgery. This is shown in table 2.
Conclusions Our study concludes that there was no significant difference in the hemoglobin drop of the patients who had clopidogrel stopped three days prior to the major procedure like CABG in comparison to the patients who stopped clopidogrel five days before surgery. We advocate, that early cessation of clopidogrel is posing a threat of thrombosis in high risk patients with no additional benefit of decreased bleeding risks. However, large population studies are needed to validate the results.
Table 1: Frequency and percentages of included population in each group.
Plavix stopped 3 or less than 3 days prior to surgery (.00) had a Hgb drop of 2.42 mg/dl vs Plavix stopped 5 days prior to the surgery (1.00) which had a Hgb drop of 2.51 mg/dl post surgery.
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