Eur J Cardiothorac Surg. age, gender, body surface area, preoperative hematocrit, preoperative prothrombin time and prior myocardial infarction. The clopidogrel group had higher12h and 24h mean chest tube output (at 12h mean 519.7ml vs 353.1 ml, p 0.05, at 24h mean 756.6 ml vs 563.5 ml, p 0.05). Moreover, reoperation for bleeding was 4.5-fold higher in the clopidogrel group (5.9% vs. 1.3%, p 0.01), and more transfusions of red RG3039 blood cells (3.23U vs 2.6 U, p 0.05), platelets (1.53U vs 1.23U, p 0.01) and fresh frozen plasma (0.84U vs 0.36 U, p 0.01). The clopidogrel group also showed a longer mechanical ventilation time (16.9h vs 12.9 h p = 0.03) and trend towards more prolonged stay in ICU (2.08 days vs 1.7 days p= 0.048). Conclusions: Clopidogrel in combination with aspirin before CABG is associated with higher postoperative bleeding, exposure to blood products and morbidity. These findings raise concern regarding the routine administration of clopidogrel before anticipated but undecided coronary stent implantation. test. Proportional differences were analyzed using the Fisher exact chi-square analysis and p value of 0. 05 was considered statistically significant. 4.?RESULTS Patient characteristics were comparable in age, gender and body surface area in both groups (Table 1). The baseline hematocrit, prothrombin time and creatinine levels were also comparable between the groups. There was a significantly prevalence of class III to IV angina (68.6% vs. 52.6%, p=0.01) in the clopidogrel group. Table 1. Baseline Characteristics thead th rowspan=”1″ colspan=”1″ /th th rowspan=”1″ colspan=”1″ Clopidogrel+Aspirin br / (n = 223pts) /th th rowspan=”1″ colspan=”1″ Non Clopidogrel+Aspirin br / (n = 77pts) /th th rowspan=”1″ colspan=”1″ P value /th /thead Age (years)66.628,3268.6012,150.18Gender (female)30.45%28.73%0.64Body surface (m2)1.820.341.800.240.75Preoperative Hb (gr/L)138.214.2137.615.30.45Prothrombine time (sec)11.61.211.21.30.28Preop platelet count (x 109)232862451050.12Preop creatinine (mg/L)10.35.411.36.10.38History of MI*55.8%48.4%0.086History of CVA**6.7%4.6%0.10History of CHF***16.9%20.7%0.12Class III or IV angina68.6%52.6%0.01 Open in a separate window Data are shown as mean SD or percentage, *MI C myocardial infarction, **CVA C cerebral vascular accident, ***CHF C congestive heart failure, The postoperative measures of bleeding and blood product transfusions are shown in Table 2. Patients in clopidogrel group had a significantly higher mean chest tube output at all time intervals compared to other group (12h and 24h p 0.05,48h p 0.01). Blood products used showed a significant statistic difference between the groups (p=0.036). Differences are statistically significant for every type of blood products used, especially for platelet transfusion (p= 0.015). Table 2. Post operation Bleeding and Transfusions thead th rowspan=”1″ colspan=”1″ /th th rowspan=”1″ colspan=”1″ Clopidogrel+Aspirin br / (n = 223pts) /th th rowspan=”1″ RG3039 colspan=”1″ Non Clopidogrel+Aspirin br / (n = 77pts) /th th rowspan=”1″ colspan=”1″ P value /th /thead Major bleeding(pts)18.8%7.8%0.008Chest tube output (ml)12 h519.7373.6353.1209.80.01624 h756.6412.8563.5347.10.01248h1137.5565.4894.2452.70.008Transfusions (U/pt)Red blood cells3.233.12.62.20.036Platelets 1.530.981.230.870.005FFP*0.841.030.360.650.003Cryoprecipitate 0.210.180.180.160.033Blood products exposureRed blood cells92.3%73.2%0.032Platelet46.5%28.7%0.015Any blood product95.8%76.3%0.036 Open in a separate window *FFP C fresh frozen plasma Referred incidence of major bleeding was significantly higher at any moment of monitoring in the patients received clopidogrel within 7 days before operation (Figure 1). Open in a separate window Figure 1. Time when major bleeding is referred The most striking finding was a 4.5-fold higher incidence of reoperation MYD118 for bleeding in the clopidogrel group (5.9% vs. 1.3%, p 0.01). In all cases reoperation was performed within first 24 hours. It was observed that patients of non clopidogrel group had a shorter time of mechanical ventilation and length of stay in ICU. More than 99% of all cases with major bleeding were manifested during first 24 hours after CABG in both groups and mainly during first 12h. Difference in frequency of major bleeding is statistically significant almost all the time span (p 0.01). Higher mortality rate was observed in the clopidogrel and aspirin group (p=0.864) and higher frequency of myocardial infarction in non clopidogrel group (p 0.05). Post operation cerebral vascular accidents and acute renal failure were more frequent in the non clopidogrel group of patients. Septic complications were significantly higher (p 0.05)in patients of the clopidogrel group, as well as length of stay in ICU. The clinical outcomes are shown in Table 3. Table 3. The clinical RG3039 outcomes thead th rowspan=”1″ colspan=”1″ /th th rowspan=”1″ colspan=”1″ Clopidogrel+Aspirin br / (n = 223pts) /th th rowspan=”1″ colspan=”1″ Non Clopidogrel+Aspirin br / (n = 77pts) /th th rowspan=”1″ colspan=”1″ P value /th /thead Reoperation for bleeding5.9%1.3%0.002Severe low cardiac output5.5%5.2%0.42Mortality4.97%3.9%0.02MI*2.2%5.2%0.012CVA**2.2%2.7%0.07Sepsis 2.2%1.3%0.04Acute renal failure1.7%2.6%0.09Mechanical ventilation (h)16.99.8712.98.880.03Length of stay in ICU (days)2.081.681.71.50.048 Open in a separate window *MI-myocardial infarction, **CVA- cerebral RG3039 vascular accident 5.?DISCUSSION Aggressive antiplatelet therapy with a combination of an ADP receptor inhibitor and aspirin is a well established practice for coronary stent thrombosis prevention (8, 9, 16, 17). The results of our study support such a standard, as post operation myocardial infarction (2.2% vs 5.2%, p=0.012) and cerebral vascular accidents (2.2% vs 2.7%, p=0.07) were higher in non clopidogrel group. Considering the pharmacological properties of clopidogrel, many RG3039 clinics use it widely in combination with aspirin as antiplatelet therapy before the diagnostic coronary angiography whenever there was a probability of subsequent.