Impact of preoperative clopidogrel in off pump coronary artery bypass surgery: A propensity score analysis

Objective: The aim of our study was to evaluate the impact of recent clopidrogel use before off-pump coronary artery bypass grafting on the postoperative risk of bleeding. Methods: During the period January 2003 to December 2006, 1104 consecutive patients underwent off- pump coronary artery bypass grafting. Patients were divided into two groups according to the recent use of clopidrogel ( within 7 days). We performed a propensity score to further adjust for differences between the patients with and without recent use of clopidrogel. Results: Mean age was 64 +/- 14 years and 87% were male. The clopidrogel group had a greater incidence of patients in unstable condition, requiring emergency coronary bypass grafting, and with a high EuroSCORE. Propensity score analysis selected 88 patients with and 176 without recent use of clopidrogel. By propensity score, the clopidrogel group had higher requirements for fresh frozen plasma units ( 18.1% vs 8.5%; P = .02), reoperation owing to bleeding ( 5.6% vs 0.5%; P = .009), and higher need for postoperative mechanical ventilation ( 4% vs 10%; P = .04), whereas mortality and length of stay were similar between groups. Conclusion: Recent use of clopidogrel before off- pump coronary artery bypass grafting is associated with greater risk for bleeding with similar mortality rate.