Impact of discontinuation of clopidogrel and aspirin before off-pump coronary artery bypass grafting on postoperative volume of drainage_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHAO Tiefu , WANG Shengyu , ZHANG Chunxiao , ZHANG Ming , WNG Jiangang , ZENG Wen , ZHENG Shuai , CHEN Hong

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;

Corresponding?author：

ZHAO Tiefu, Email: tiefuzhao@163.com

Keywords：

Coronary artery bypass grafting; off-pump; clopidogrel; aspirin; surgical treatment

DOI：

10.7507/1007-4848.202003044

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Objective To investigate the influence of different discontinuation time of clopidogrel and aspirin before off-pump coronary artery bypass grafting on postoperative volume of drainage and blood products imported.Methods A total of 454 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital from January 2017 through December 2019 were included. According to the preoperative discontinuation of clopidogrel and aspirin, all the 454 patients were divided into three groups including a guide group, a non-stop group and a stop group. There were 86 patients in the guide group including 59 males and 27 females with an average age of 64.12±6.15 years. They continued to take aspirin 100 mg/d before operation, but stopped clopidogrel for more than 5 days. In the non-stop group, there were 234 patients including 141 males and 93 females with an average age of 63.71±7.01 years. They continued to take aspirin 100 mg/d before operation, and stopped clopidogrel <5 days. In the stop group, there were 134 patients including 76 males and 58 females with an average age of 62.90±7.78 years. They stopped aspirin and clopidogrel for more than 5 days before operation. The clinical effectiveness was compared among the three groups.Results No perioperative death occurred in all patients. There was no statistical difference in platelet count, coagulation function, liver function, renal function, or myocardial markers among the groups (P>0.05). The hemoglobin [97 (15) g/ L vs. 98 (21) g/L vs. 100 (20) g/ L, F=4.894, P=0.008] in the non-stop group was lower than that in the guide group and the non-stop group at 30 minutes postoperatively. The flow volume (399.87±127.19 mL vs. 367.05±125.89 mL vs. 349.63±130.68 mL, F=7.770, P=0.000) in the non-stop group at 3 hours postoperatively, the flow volume [600 (300) mL vs. 580 (245) mL vs. 550 (350) mL, Z=8.218, P=0.016] in the non-stop group at 6 hours postoperatively, the flow volume [750 (370) mL vs. 730 (350) mL vs. 730 (350) mL, Z=8.329, P=0.016] in the non-stop group at 12 hours postoperatively, the flow volume [890 (365) mL vs. 850 (340) mL vs. 850 (350) mL vs. Z=6.585, P=0.037] in the non-stop group at 24 hours postoperatively and the flow volume [950 (375) mL vs. 940 (360) mL vs. 940 (380) mL, Z=8.680, P=0.013] in the non-stop group at 48 hours postoperatively were more than those of the guide group and the stop group. The retention time of drainage tube was longer in the non-stop group [3 (1) d vs. 3 (1) d vs. 3 (1) d, Z=6.579, P=0.037] than in the guide group and the non-stop group. The amount of suspended erythrocytes input [0 (2) U vs. 0 (2) U vs. 0 (0) U, Z=6.150, P=0.046], and the amount of plasma input [200 (200) mL vs. 0 (200) mL vs. 0 (200) mL, F=4.144, P=0.016], the number of cases of plasma input (119 patients vs. 34 patients vs. 47 patients, Z=10.116, P=0.006) were more than those of the guide group and the stop group.Conclusion Aspirin maintenance is recommended for patients before off-pump coronary artery bypass grafting. If not necessary, clopidogrel is discontinued for at least 5 days.

Citation： ZHAO Tiefu, WANG Shengyu, ZHANG Chunxiao, ZHANG Ming, WNG Jiangang, ZENG Wen, ZHENG Shuai, CHEN Hong. Impact of discontinuation of clopidogrel and aspirin before off-pump coronary artery bypass grafting on postoperative volume of drainage. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(4): 453-458. doi: 10.7507/1007-4848.202003044 Copy

1.	Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation, 2004, 110(14): e340-e437.
2.	Ferraris VA, Ferraris SP, Moliterno DJ, et al. The Society of Thoracic Surgeons practice guideline series: Aspirin and other antiplatelet agents during operative coronary revascularization (executive summary). Ann Thorac Surg, 2005, 79(4): 1454-1461.
3.	Shahian DM, Smith PK, Byrne JG, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23): 2610-2642.
4.	Sousa-Uva M, Head SJ, Milojevic M, et al. 2017 EACTS guidelines on perioperative medication in adult cardiac surgery. Eur J Cardio-thorac Surg, 2018, 53(1): 5-33.
5.	Ferraris VA, Saha SP, Oestreich JH, et al. 2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drags in patients having cardiac and noncardiac operations. Ann Thorac Surg, 2012, 94(5): 1761-1781.
6.	冠狀動脈旁路移植術圍手術期抗血小板治療共識專家組. 冠狀動脈旁路移植術圍手術期抗血小板治療專家共識. 中華胸心血管外科雜志, 2016, 32(1): 1-8.
7.	Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-summary article: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol, 2002, 40(7): 1366-1374.
8.	Tom?i? A, Schotborgh MA, Manshanden JS, et al. Coronary artery bypass grafting-related bleeding complications in patients treated with dual antiplatelet treatment. Eur J Cardiothorac Surg, 2016, 50(5): 849-856.
9.	劉培生, 陳鑫, 石開虎, 等. 術前氯吡格雷對冠狀動脈旁路移植術手術效果的影響. 中華外科雜志, 2008, 46(4): 252-255.
10.	鄭澤, 柳景華, 黃方炯, 等. 冠狀動脈旁路移植術前應用阿司匹林和氯吡格雷不同方案對近期預后的影響. 中華醫學雜志, 2013, 93(38): 3060-3062.
11.	Hansson EC, Jiděus L, Aberg B, et a1. Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or elopidogrel: a nationwide study. Eur Heart J, 2016, 37(2): 189-197.
12.	王梓, 夏利民, 宋凱, 等. 不停跳冠狀動脈旁路移植術前停用阿司匹林及氯吡格雷對術后出血和輸血的影響. 中華外科雜志, 2019, 57(3): 187-193.
13.	Shim JK, Choi YS, Oh YJ, et al. Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery. J Thorac Cardiovasc Surg, 2007, 134(1): 59-64.
14.	Deja MA, Kargul T, Domaradzki W, et al. Effects of preoperative aspirin in coronary artery bypass grafting: a double-blind, placebo, controlled, randomized trial. J Thorac Cardiovasc Surg, 2012, 144(1): 204-209.
15.	Biondi-Zoccai G, Lotroionte M, Agostoni P, et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50279 patients at risk for coronary artery disease. Eur Heart J, 2006, 27(22): 2667-2674.
16.	Mihos CG, Xydas S, Williams RF, et al. Staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for two-vessel coronary artery disease and moderate to severe ischemic mitral regurgitation. J Thorac Dis, 2017, 9(Suppl 7): 563-568.
17.	Kizilay M, Asian Z, Vural U, et al. Is preoperative clopidogrel resistance a predictor of bleeding and risks in patients undergoing emergency CABG surgery. Braz J Cardiovasc Surg, 2018, 33(4): 330-338.
18.	Ma E, Suarez TA, Bliden KP, et al. Platelet function measurement-based strategy to reduce bleeding and waiting time in elopidogrel-treated patients undergoing coronary artery bypass graft surgery: the timing based on platelet function strategy to reduce clopidogrel-associated bleeding related to CABG (TARGET-CABG) study. Circ Cardiovasc Interv, 2012, 5(2): 261-269.

1. Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation, 2004, 110(14): e340-e437.
2. Ferraris VA, Ferraris SP, Moliterno DJ, et al. The Society of Thoracic Surgeons practice guideline series: Aspirin and other antiplatelet agents during operative coronary revascularization (executive summary). Ann Thorac Surg, 2005, 79(4): 1454-1461.
3. Shahian DM, Smith PK, Byrne JG, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23): 2610-2642.
4. Sousa-Uva M, Head SJ, Milojevic M, et al. 2017 EACTS guidelines on perioperative medication in adult cardiac surgery. Eur J Cardio-thorac Surg, 2018, 53(1): 5-33.
5. Ferraris VA, Saha SP, Oestreich JH, et al. 2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drags in patients having cardiac and noncardiac operations. Ann Thorac Surg, 2012, 94(5): 1761-1781.
6. 冠狀動脈旁路移植術圍手術期抗血小板治療共識專家組. 冠狀動脈旁路移植術圍手術期抗血小板治療專家共識. 中華胸心血管外科雜志, 2016, 32(1): 1-8.
7. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-summary article: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol, 2002, 40(7): 1366-1374.
8. Tom?i? A, Schotborgh MA, Manshanden JS, et al. Coronary artery bypass grafting-related bleeding complications in patients treated with dual antiplatelet treatment. Eur J Cardiothorac Surg, 2016, 50(5): 849-856.
9. 劉培生, 陳鑫, 石開虎, 等. 術前氯吡格雷對冠狀動脈旁路移植術手術效果的影響. 中華外科雜志, 2008, 46(4): 252-255.
10. 鄭澤, 柳景華, 黃方炯, 等. 冠狀動脈旁路移植術前應用阿司匹林和氯吡格雷不同方案對近期預后的影響. 中華醫學雜志, 2013, 93(38): 3060-3062.
11. Hansson EC, Jiděus L, Aberg B, et a1. Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or elopidogrel: a nationwide study. Eur Heart J, 2016, 37(2): 189-197.
12. 王梓, 夏利民, 宋凱, 等. 不停跳冠狀動脈旁路移植術前停用阿司匹林及氯吡格雷對術后出血和輸血的影響. 中華外科雜志, 2019, 57(3): 187-193.
13. Shim JK, Choi YS, Oh YJ, et al. Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery. J Thorac Cardiovasc Surg, 2007, 134(1): 59-64.
14. Deja MA, Kargul T, Domaradzki W, et al. Effects of preoperative aspirin in coronary artery bypass grafting: a double-blind, placebo, controlled, randomized trial. J Thorac Cardiovasc Surg, 2012, 144(1): 204-209.
15. Biondi-Zoccai G, Lotroionte M, Agostoni P, et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50279 patients at risk for coronary artery disease. Eur Heart J, 2006, 27(22): 2667-2674.
16. Mihos CG, Xydas S, Williams RF, et al. Staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for two-vessel coronary artery disease and moderate to severe ischemic mitral regurgitation. J Thorac Dis, 2017, 9(Suppl 7): 563-568.
17. Kizilay M, Asian Z, Vural U, et al. Is preoperative clopidogrel resistance a predictor of bleeding and risks in patients undergoing emergency CABG surgery. Braz J Cardiovasc Surg, 2018, 33(4): 330-338.
18. Ma E, Suarez TA, Bliden KP, et al. Platelet function measurement-based strategy to reduce bleeding and waiting time in elopidogrel-treated patients undergoing coronary artery bypass graft surgery: the timing based on platelet function strategy to reduce clopidogrel-associated bleeding related to CABG (TARGET-CABG) study. Circ Cardiovasc Interv, 2012, 5(2): 261-269.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Impact of discontinuation of clopidogrel and aspirin before off-pump coronary artery bypass grafting on postoperative volume of drainage

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