Effects of Preoperative Combined Antiplatelet Agents on the Postoperative Bleeding that Occurs during Off-pump Coronary Artery Bypass Surgery

Choi, Kang Joo; Seong, Hoo Sik; Kae, Yoe Kon

Abstract

BACKGROUND: It is well known that preoperative administration of combined antiplatelet agents can have an impact on the postoperative bleeding, the requirement for transfusion and the need for reexploration during on-pump coronary artery bypass surgery. Yet its effects have not been well evaluated in the case of off-pump coronary artery bypass surgery. MATERIAL AND METHOD: We performed a retrospective study of nineteen patients who underwent OPCAB from March 2003 to December 2004. All the patients had taken antiplatelet agents until 12 hours before operation. The patients were divided into two groups as an aspirin group and a combined (aspirin+clopidogrel) group. The perioperative platelet count, the hemoglobin level, the hematocrit, the prothrombin time and the aPTT were compared between both groups. The amount of postoperative bleeding, the transfusion requirement and the need for re-exploration to control bleeding were also compared between both groups. RESULT: There was no difference of operation time and the intraoperative ACT between the aspirin group and the combined group. The amount of blood loss through the chest tube for 24 hours was not different between the aspirin group (697+/-271 mL) and the combined group (944+/-432 mL). The number of patients who received blood transfusion was also not different between both groups. There was no patient who required reexploration for bleeding control in both groups. The perioperative hemoglobin level and hematocrit were also not different between both groups, but the postoperative hemoglobin level and hematocrit were decreased significantly in the group. CONCLUSION: The preoperative combined antiplatelet (aspirin+clopidogrel) therapy group was not different from the aspirin group for the amount of postoperative bleeding, the amount of blood transfusion and the need for reexploration during off-pump coronary artery bypass grafting. This subject needs further evaluation because of small population in our study.