Impact of preoperative clopidogrel and aspirin on bleeding complications in off pump coronary artery bypass grafting

Introduction: Clopidogrel in isolation or as dual antipatelet threrapy (with aspirin) has been the mainstay of antiplatelet therapy for critical coronary artery disease and interventions. Guidelines recommend stoppage of clopidogrel at about 5 days prior to any major surgical procedure. In the clinical setting however more often than not we may need expedited surgery where antiplatelets may not be optimally discontinued. We share our experience in a similar setting to compare bleeding complications in the above subset of patients undergoing off pump coronary artery bypass grafting
Patients and methods: Retrospective data collected from July 2018 to March 2020. Patients who underwent off pump coronary artery bypass grafting were included and divided in two groups ,group I with clopidogrel aspirin discontinued just 24 hours pre surgery and group II where the same dual antiplatelets were discontinued 5 days prior to off pump CABG.. The groups were demographically matched and their perioperative data compared.
Results: Fall in platelet count, total drainage, units of blood transfusion were higher in group I and was statistically significant (p value 0.004).. There was no significant difference in left ventricular ejection fraction, number of grafts ,ICU and hospital stay and operative mortality in these groups.
Conclusion: Optimally patients on clopidogrel+ aspirin subjected to elective surgery are best served by discontinuation of these drugs atleast 5 days prior to surgery .However in conditions requiring expedited surgery, Off pump CABG can be safely carried out with a minimally increased risk of increased blood transfusion.