ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Off-pump coronary artery bypass grafting under clopidogrel treatment
Mustafa Emmiler1, Raif Umut Ayoğlu1, Ömer Haldun Tekinalp1, Şakir Arslan2
1Departments of Cardiovascular Surgery, Antalya Training and Research Hospital, Antalya, Turkey
2Departments of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey
DOI : 10.5606/tgkdc.dergisi.2016.13286
Background: This study aims to compare the myocardial damage, inflammation and early postoperative morbidity and mortality following coronary artery bypass grafting in patients receiving and not receiving clopidogrel preoperatively.

Methods: Between April 2008 and May 2014, 91 patients who underwent isolated off-pump coronary artery bypass grafting due to acute coronary syndrome were included. Of these patients, 48 (13 females, 35 males; mean age 65.3±8.3 years; range, 52 to 79 years) received clopidogrel (clopidogrel group) and 43 (10 females, 33 males; mean age 63.1±7.7 years; range, 49 to 76 years) did not use clopidogrel before surgery (control group). Levels of creatine phosphokinase-myocardial band, troponin I, C-reactive protein, and the amount of intraoperative blood loss, transfusion requirements, postoperative chest tube output, the length of hospital and intensive care unit stay, postoperative ejection fraction, and the incidence of postoperative atrial fibrillation of both groups were analyzed.

Results: Postoperative troponin I and C-reactive protein levels were significantly lower in the clopidogrel group (p<0.01). A significantly lower number of patients in the clopidogrel group developed postoperative atrial fibrillation (13% vs 30%; p<0.05). However, postoperative chest tube output was significantly higher in the clopidogrel group, than the control group (883.2±256.9 mL vs 766.7±218.4 mL; p<0.02).

Conclusion: Although preoperative clopidogrel use increases chest tube output after emergency offpump coronary artery bypass grafting, this increase is tolerable. During and after surgery, protective effects of clopidogrel can be achieved, such as reduced postoperative troponin levels and reduced postoperative atrial fibrillation development. Preoperative clopidogrel use does not preclude early coronary artery bypass grafting.

Keywords : Atrial fibrillation; clopidogrel; ejection fraction; myocardial protection; off-pump coronary artery bypass grafting
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