Risk factors of major bleeding in patients undergoing off-pump coronary artery bypass grafting / 中华胸心血管外科杂志

ABSTRACT

Objective To identify the risk factors of major bleeding in patients undergoing off-pump coronary artery by-pass grafting( OPCAB) .Methods Data on coronary artery disease patients who underwent off-pump CABG between December 2009 and December 2014 were reviewed.Baseline characteristics were compared between patients with clopidogrel discontinua-tion ≥5 days and <5 days.Univariate and multivariate logistic regression analyses were performed to investigate the risk fac-tors of perioperative major bleeding.Major bleeding was defined as the Universal Definition of Perioperative Bleeding(UDPB) class 3 -4.Results A total of 3988 patients who underwent OPCAB were included in this study.Major bleeding rate was 9.23%(n=368).Multivariable regression analysis showed that female sex(OR=1.99, 95%CI1.57-2.52), age(OR=1. 02, 95%CI1.00-1.03), lower BMI(BMI≤25 kg/m2)(OR=1.40,95%CI1.12-1.75), decreased GRF(GFR<60 ml/min)(OR=1.43,95%CI1.01-2.02), decreased preoperative Hct(Hct <0.40)(OR =1.57, 95%CI 1.23-1.99) and clopidogrel discontinuation <5 days(OR=1.97, 95%CI1.58-2.44) conferred a higher risk of perioperative major bleeding during OPCABG.Conclusion Female, advanced age, lower BMI, decreased GRF, decreased preoperative Hct and clopi-dogrel discontinuation<5 days are independent risk factors of perioperatice major bleeding in patients undergoing OPCAB .Pre-dicting risk of major bleeding can help sugeons to optimize perioperative management .