Early use of clopidogrel after coronary artery by-pass grafting

ABSTRACT

A better preserved hemostasis increases the risk of thrombosis, which is of particular importance for the patency of coronary anastomosis. Thromboembolic complications seem to be more frequent following off-pump coronary artery by-pass [OP CAB] than after conventional coronary Artery by-pass grafting [CABG], it is not known whether the conventional antiplatelet treatment, as established for on-pump procedures, is optimal for OPCAB-patients. Clopidogrel is a potent platelet aggregation inhibitor, that has gained widespread acceptance for the treatment of acute coronary syndromes and as an adjunct to percutaneous coronary intervention. Is to detect safety and efficacy of administration of clopidogrel early post-operative. Seventy five patients who underwent primary isolated CABG in Alexandria Forty two patients received dopidogrel after OPCAB or conventional on pump coronary artery bypass grafting according to surgeon's decision. The rest of patients didn't receive dopidogrel. Patients were divided into two groups, dopidogrel group [42 patients 56%] had received dopidogrel post-operatively, the no-clopidogrel group [33patients 44%] didn't receive dopidogrel. Post-operative bleeding, chest tube drainage, blood transfusion was detected. In the dopidogrel group, 38 patients [90.5%] received blood transfusions, and the mean number of packed red blood cells transfused during hospitalization was 3.8 +/- 2.2 units. In the second group, 29 patients [87.8%] received blood transfusions, and the mean number of packed red blood cells transfused was 3.5 +/- 2.6 units. No significant differences were noted in the development of early postoperative [within 30 days] pleural effusions requiring thoracentesis. This study documents the safety of early dopidogrel administration after coronary revascularization when administered according to a defined postoperative protocol. Major gastrointestinal bleeding is considered of most frequent risk and needs to be considered