관상동맥 우회술 전 clopidogrel 중단시점에 관한 고찰
Evaluation of clopidogrel discontinuing time before coronary artery bypass graft
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Clopidogrel reduces atherosclerotic events in patients with atherosclerosis. Premedication with clopidogrel has reduced thrombotic complications after percutaneous coronary revascularization procedures. However, because of the enhanced and irreversible platelet inhibition by clopidogrel, patients requiring surgical revascularization have a higher risk of bleeding complications and transfusion requirements. Especially, for patients who have received clopidogrel for acute coronary syndrome and are scheduled for Coronary Artery Bypass Graft (CABG), discontinuing clopidogrel for 5 days prior to the scheduled surgery is recommended. The purpose of this study was to review whether clopidogrel was discontinued at the right time before CABG in Seoul National University Hospital(SNUH) and evaluate the effect of preoperative clopidogrel administration in the incidence of hemostatic reexploration and blood product transfusion rate. Data were collected retrospectively on 99 consecutive CABG patients who have received clopidogrel before surgery from January 2006 through December 2006 at SNUH. Outcome comparisons were studied between two groups : clopidogrel administered within 5 days of operation(n = 53, 53.5%), and clopidogrel discontinued more than 5 days before operation(n =46, 46.5%). The mean total blood product transfusions were 1428ml and 2109ml, respectively(p =0.049). There were no statistically significant differences in hemostatic reoperations. We have shown that clopidogrel use within 5 days of CABG is associated with the requirements for blood product transfusions after coronary artery bypass surgery, so pharmacists should recommend discontinuing clopidogrel administration at the appropriate time before CABG to doctors.
Abstract
Clopidogrel reduces atherosclerotic events in patients with atherosclerosis. Premedication with clopidogrel has reduced thrombotic complications after percutaneous coronary revascularization procedures. However, because of the enhanced and irreversible platelet inhibition by clopidogrel, patients requiring surgical revascularization have a higher risk of bleeding complications and transfusion requirements. Especially, for patients who have received clopidogrel for acute coronary syndrome and are scheduled for Coronary Artery Bypass Graft (CABG), discontinuing clopidogrel for 5 days prior to the scheduled surgery is recommended. The purpose of this study was to review whether clopidogrel was discontinued at the right time before CABG in Seoul National University Hospital(SNUH) and evaluate the effect of preoperative clopidogrel administration in the incidence of hemostatic reexploration and blood product transfusion rate. Data were collected retrospectively on 99 consecutive CABG patients who have received clopidogrel before surgery from January 2006 through December 2006 at SNUH. Outcome comparisons were studied between two groups : clopidogrel administered within 5 days of operation(n = 53, 53.5%), and clopidogrel discontinued more than 5 days before operation(n =46, 46.5%). The mean total blood product transfusions were 1428ml and 2109ml, respectively(p =0.049). There were no statistically significant differences in hemostatic reoperations. We have shown that clopidogrel use within 5 days of CABG is associated with the requirements for blood product transfusions after coronary artery bypass surgery, so pharmacists should recommend discontinuing clopidogrel administration at the appropriate time before CABG to doctors.
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