Hypercoagulability and platelet inhibition after OPCAB. Randomized intervention with clopidogrel.

Abstract

OBJECTIVE:

Data on graft patency after Off-Pump Coronary Artery Bypass (OPCAB) suggest that the incidence of early graft closure is not increased compared to conventional coronary artery bypass surgery. However, hypercoagulability following OPCAB is still of concern, and acetylsalicylic acid as thromboembolic prophylaxis might be insufficient in the first weeks following OPCAB surgery.

DESIGN:

Twenty nine patients were randomly assigned to+/- 75 mg of clopidogrel until 30 days after OPCAB surgery. The follow-up time was 2 months including standard blood samples and thrombelastography (TEG) with a specific platelet inhibition assay, which was evaluated as a part of the study.

RESULTS:

In both groups a significant increase in TEG maximum amplitude was found 5 days after surgery. Platelet inhibition showed great variations but was significantly increased in the clopidogrel group (34.1%) vs. control group (11.0%) after 1 month.

CONCLUSION:

Hypercoagulability was seen 5 days after OPCAB and could not be demonstrated after 1 month. No clinical effects of the hypercoagulability were observed, and further research is needed to determine if clopidogrel should be recommended after OPCAB.

• Authors: Allan Bybeck Nielsen, Louise Bochsen, Daniel A Steinbrüchel
• Journal: Scandinavian cardiovascular journal : SCJ (Scand Cardiovasc J) Vol. 41 Issue 5 Pg. 325-30 (Oct 2007) ISSN: 1401-7431 [Print] England
• PMID: 17852789 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticlopidine

Topics

• Adult
• Aged
• Aged, 80 and over
• Anticoagulants (pharmacology)
• Clopidogrel
• Coronary Artery Bypass, Off-Pump
• Female
• Humans
• Male
• Middle Aged
• Platelet Activation (drug effects)
• Platelet Aggregation Inhibitors (pharmacology)
• Prospective Studies
• Thrombelastography
• Thromboembolism
• Thrombophilia
• Ticlopidine (analogs & derivatives, pharmacology)