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When is the optimal time to discontinue clopidogrel before in-hospital coronary bypass surgery? A closer look at the current literature.

Authors
  • Mokhtar, Ahmed T1, 2
  • Baghaffar, Abdullah3
  • Jackson, Simon D1
  • Horne, David3
  • 1 Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. , (Canada)
  • 2 Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. , (Saudi Arabia)
  • 3 Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. , (Canada)
Type
Published Article
Journal
Journal of Cardiac Surgery
Publisher
Wiley (Blackwell Publishing)
Publication Date
Dec 05, 2019
Identifiers
DOI: 10.1111/jocs.14371
PMID: 31803992
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Clopidogrel and other P2Y12 inhibitors have become the standard of care among patients presenting with acute coronary syndromes. A substantial proportion of these patients require surgical revascularization during index hospitalization. Guidelines recommend a 5-day waiting period off clopidogrel before coronary artery bypass grafting (CABG) to reduce hemorrhagic complications. These recommendations are not routinely followed in clinical practice, while recent studies also propose shorter waiting periods off clopidogrel for patients awaiting in-hospital CABG. A preliminary PubMed search was conducted using the following MeSH terms under the publication type "Hemorrhage:" "Clopidogrel," AND "Coronary Artery Bypass." Relevant studies and guidelines were then reviewed and selected based on a predetermined criteria. Studies that formulated the current recommendations for stopping clopidogrel preoperative to CABG are discussed in detail this review. A comprehensive review of recent evidence illustrates mixed bleeding and transfusion outcomes among CABG patients with preoperative exposure to clopidogrel in less than 5 days. The optimal discontinuation time of clopidogrel before CABG is still poorly defined. The recommendation of a 5-day washout period for clopidogrel should be reconsidered to be on par with current clinical practice. © 2019 Wiley Periodicals, Inc.

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