Optimal Duration for Clopidogrel Suspension Prior to Coronary Artery Bypass Grafting
Notice bibliographique
Résumé
BACKGROUND: American College of Cardiology (ACC) guidelines suggest clopidogrel (Plavix) suspension for 5 days before non-emergent cardiac surgery (class IIa, level B). It puts the patients with recent angioplasty and ongoing ischemia at a higher risk of stent thrombosis. We sought to determine the bleeding risk in patients who stopped clopidogrel at 3 and less than 3 days before coronary artery bypass grafting (CABG) as compared to the usual 5 days prior to CABG. METHODS: A retrospective single center study was performed; and a total of 90 patients were included. Forty patients were not on clopidogrel but underwent CABG and hence were used as a control group (group 3). Fifty remaining patients were divided into three groups. Patients in whom clopidogrel was stopped 3 days or less before CABG were included in group 1 (n = 25); group 2 included patients who followed the standard ACC guidelines and clopidogrel was suspended 5 days before the CABG (n = 17); and finally patients who had stopped clopidogrel 4 days prior to surgery were included in group 4 (n = 8). This was compared to controls. Postoperative hemoglobin drop was analyzed between subgroups using IBM SPSS version 25. RESULTS: The mean age of the included population was 69.9 years (46 - 88) with 65% of them being male and 35% female patients. The difference in the hemoglobin fall was compared amongst these groups using the one-way ANOVA. There were no outliers, as assessed by boxplot, the data were normally distributed for each group, as assessed by Shapiro-Wilk test (P > 0.05), and there was homogeneity of variances, as assessed by Levene's test of homogeneity of variances (P > 0.05). The fall in hemoglobin for the four different groups was analyzed. The fall in hemoglobin in group 1 (stopped clopidogrel 3 days or less before CABG) was (n = 25, 2.36 ± 1.24), the fall in group 2 (stopped clopidogrel 5 days prior to CABG) was (n = 17, 2.89 ± 1.22), the fall in hemoglobin in group 3 (patients not on clopidogrel) was (n = 40, 2.54 ± 1.35), and the fall in hemoglobin in group 4 (patients stopped clopidogrel 4 days prior to CABG) was (n = 8, 2.02 ± 1.31). ANOVA was subsequently performed on the patient data, which showed no statistical difference between all the four groups regarding the fall in hemoglobin during surgery (P = 0.41). CONCLUSIONS: Our study concludes that there was no significant difference in the hemoglobin drop of the patients who had clopidogrel stopped 3 days prior to the major procedure like CABG in comparison to the patients who stopped clopidogrel 5 days before surgery. We advocate, that early cessation of clopidogrel is posing a threat of thrombosis in high risk patients with no additional benefit of decreased bleeding risks. However, large population studies are needed to validate the results.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».