Clopidogrel use after myocardial revascularization: prevalence, predictors, and one-year survival rate

Abstract Introduction: Antiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario. Objective: Identify predictors of clopidogrel following CABG. Methods: We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG. Results: At hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032). Conclusion: Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG.

Hematological profile of sickle cell disease: A hospital based study at CIMS, Bilaspur, Chhattisgarh.

Hematological profile of total 1260 individuals were tested for Sickle Cell Disease who attended CIMS OPD, Bilaspur during a period of May 2008 to October 2009 is presented here. At least 4.44% of the total subjects tested were identified as homozygous for sickle cell gene (SS) and 35% were with sickle cell trait (AS). The patients were confirmed by examining the blood samples for solubility test and hemoglobin electrophoresis using cellulose acetate membrane. Among the SS patients about 58% were males and 42% were females and their ages vary from 7 months to 65 years. The SS patients showed comparatively low level of hemoglobin as well as the RBC count in both the sexes than the AS or normal subjects (AA). PCV was higher in males (31.44±3.1%) than in females (28.62±3.6%). Average MCH and MCHC did not show any significant difference between the sexes. MCV and MCHC were found to be quite higher in SS subjects than AS or AA. Thus in absence of any definite data this investigation may put some insight on the incidence of sickle cell disease in Chhattisgarh.