Yonsei Med J.  2014 Jan;55(1):224-231. 10.3349/ymj.2014.55.1.224.

The Influence of Hypothermia on Transfusion Requirement in Patients Who Received Clopidogrel in Proximity to Off-Pump Coronary Bypass Surgery

• Lee BR
• Song JW
• Kwak YL
• Yoo KJ
• Shim JK

• KMID: 1779910
• DOI: http://doi.org/10.3349/ymj.2014.55.1.224

Abstract

PURPOSE
Hypothermia adversely affects the coagulation that could be of clinical significance in patients receiving clopidogrel. We evaluated the influence of hypothermia on transfusion requirements in patients undergoing isolated off-pump coronary artery bypass surgery (OPCAB) who continued clopidogrel use within 5 days of surgery.
MATERIALS AND METHODS
Protocol-based, prospectively entered data of 369 patients were retrospectively reviewed. The time-weighted average of intraoperative temperatures and the temperature upon ICU admission (TWA-temp) was assessed. Patients were divided into normothermia (> or =36degrees C, n=224) and hypothermia (<36degrees C, n=145) group. The transfusion requirement for perioperative blood loss was assessed and compared.
RESULTS
Patients with hypothermia were older and had lower body surface area (BSA) than patients with normothermia. Age and BSA adjusted transfusion requirement was significantly larger in the hypothermia group [patients requiring transfusion: 64% versus 48%, p=0.003; number of units: 0 (0-2) units versus 2 (0-3) units, p=0.002]. In multivariate analysis of predictors of perioperative multiple transfusion requirements, hypothermia was identified as an independent risk factor along with age, female gender, BSA, chronic kidney disease, and congestive heart failure.
CONCLUSION
Hypothermia was associated with increased transfusion requirement in patients undergoing OPCAB who received clopidogrel in proximity to surgery. Considering the high prevalence and the possibility of hypothermia being a modifiable risk factor, aggressive measures should be undertaken to maintain normothermia in those patients.

Keyword

Clopidogrel; hypothermia; off-pump coronary artery bypass surgery; transfusion

MeSH Terms

Aged
Coronary Artery Bypass, Off-Pump/*methods
Female
Humans
Hypothermia/*physiopathology
Male
Middle Aged
Retrospective Studies
Ticlopidine/*analogs & derivatives/therapeutic use
Ticlopidine

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