Off - pump coronary artery bypass grafting on patients with preoperative dual antiplatelets: our centre experience
Keywords:Dual antiplatelet therapy, Off-pump coronary artery bypass grafting, Clopidogrel, Aspirin, Bleeding
Background: With the advances in percutaneous intervention techniques, the majority of patients referred for coronary artery bypass grafting (CABG) are on aspirin and clopidogrel. Standard guidelines suggest to stop clopidogrel 5 days and continue aspirin before surgery. We aim to report our centre experience on effects of continuation of preoperative clopidogrel on postoperative bleeding and use of blood products after off- pump CABG (OP-CABG).
Methods: This retrospective study included 120 consecutive patients who underwent isolated OP-CABG operation between Nov 2019 and March 2021 in our centre. Data was obtained from hospital records. Patients were divided into two groups: Group-1: this group consists of 86 patients. All patients included were elective CABG cases with preoperative Clopidogrel 75 mg discontinued 3-5 days before surgery. Group-2: this group consists of 34 patients. All patients included were urgent CABG cases with preoperative Clopidogrel 75 mg discontinued 24 hours before surgery. Aspirin 75 mg was continued in both groups till surgery. Preoperative, intraoperative and postoperative data was recorded.
Results: 120 patients were enrolled in the study. There was no statistical significance in postoperative bleeding, re-exploration and use of blood products between the two groups. However, use of total arterial vascularisation and operative time was significant among the groups. The postoperative outcome was similar in both the groups.
Conclusions: OP-CABG can be done safely in patients requiring urgent surgery. However, clopidogrel should be stopped 3-5 days in patients undergoing elective surgeries as it influences graft selection, prolongs operative time and exposes the patients to unnecessary risks.
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