OBJECTIVES: We sought to characterize patterns of clopidogrel use before coronary artery bypass grafting (CABG) and examine the drug's impact on risks for postoperative transfusions among patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). BACKGROUND: Adherence in community practice to American College of Cardiology/American Heart Association guidelines for clopidogrel use among NSTE ACS patients has not been previously characterized. METHODS: We evaluated 2,858 NSTE ACS patients undergoing CABG at 264 hospitals participating in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Initiative. We examined the patterns of acute clopidogrel therapy and its association with bleeding risks among those having "early" CABG < or =5 days and again among those having "late" surgery >5 days after catheterization. RESULTS: Within 24 h of admission, 852 patients (30%) received clopidogrel. In contrast to national guidelines, 87% of clopidogrel-treated patients underwent CABG < or =5 days after treatment. Among those receiving CABG within < or =5 days of last treatment, the use of clopidogrel was associated with a significant increase in blood transfusions (65.0% vs. 56.9%, adjusted odds ratio [OR] 1.36, 95% confidence interval [CI] 1.10 to 1.68) as well as the need for transfusion of > or =4 U of blood (27.7% vs. 18.4%, OR 1.70, 95% CI 1.32 to 2.19). In contrast, acute clopidogrel therapy was not associated with higher bleeding risks if CABG was delayed >5 days (adjusted OR 1.18, 95% CI 0.54 to 2.58). CONCLUSIONS: Despite guideline recommendations, the overwhelming majority of NSTE ACS patients treated with acute clopidogrel needing CABG have their surgery within < or =5 days of treatment. A failure to delay surgery is associated with increased blood transfusion requirements that must be weighed against the potential clinical and economic impacts of such delays.
OBJECTIVES: We sought to characterize patterns of clopidogrel use before coronary artery bypass grafting (CABG) and examine the drug's impact on risks for postoperative transfusions among patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). BACKGROUND: Adherence in community practice to American College of Cardiology/American Heart Association guidelines for clopidogrel use among NSTE ACSpatients has not been previously characterized. METHODS: We evaluated 2,858 NSTE ACSpatients undergoing CABG at 264 hospitals participating in the CRUSADE (Can Rapid Risk Stratification of Unstable AnginaPatients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Initiative. We examined the patterns of acute clopidogrel therapy and its association with bleeding risks among those having "early" CABG < or =5 days and again among those having "late" surgery >5 days after catheterization. RESULTS: Within 24 h of admission, 852 patients (30%) received clopidogrel. In contrast to national guidelines, 87% of clopidogrel-treated patients underwent CABG < or =5 days after treatment. Among those receiving CABG within < or =5 days of last treatment, the use of clopidogrel was associated with a significant increase in blood transfusions (65.0% vs. 56.9%, adjusted odds ratio [OR] 1.36, 95% confidence interval [CI] 1.10 to 1.68) as well as the need for transfusion of > or =4 U of blood (27.7% vs. 18.4%, OR 1.70, 95% CI 1.32 to 2.19). In contrast, acute clopidogrel therapy was not associated with higher bleeding risks if CABG was delayed >5 days (adjusted OR 1.18, 95% CI 0.54 to 2.58). CONCLUSIONS: Despite guideline recommendations, the overwhelming majority of NSTE ACSpatients treated with acute clopidogrel needing CABG have their surgery within < or =5 days of treatment. A failure to delay surgery is associated with increased blood transfusion requirements that must be weighed against the potential clinical and economic impacts of such delays.
Authors: James D Douketis; Alex C Spyropoulos; Frederick A Spencer; Michael Mayr; Amir K Jaffer; Mark H Eckman; Andrew S Dunn; Regina Kunz Journal: Chest Date: 2012-02 Impact factor: 9.410
Authors: Antonio Miceli; Simon M J Duggan; Giuseppe Aresu; Paolo M de Siena; Francesco Romeo; Mattia Glauber; Massimo Caputo; Gianni D Angelini Journal: Eur J Cardiothorac Surg Date: 2012-06-24 Impact factor: 4.191
Authors: David Fitchett; John Eikelboom; Stephen Fremes; David Mazer; Steve Singh; Bindu Bittira; Stephanie Brister; John J Graham; Milan Gupta; Keyvan Karkouti; Agnes Lee; Michael Love; Rod McArthur; Mark Peterson; Subodh Verma; Terrence M Yau Journal: Can J Cardiol Date: 2009-12 Impact factor: 5.223
Authors: Hae Chang Jeong; Youngkeun Ahn; Myung Ho Jeong; Shung Chull Chae; Seung Ho Hur; Taek Jong Hong; Young Jo Kim; In Whan Seong; Jei Keon Chae; Jay Young Rhew; In Ho Chae; Myeong Chan Cho; Jang Ho Bae; Seung Woon Rha; Chong Jin Kim; Donghoon Choi; Yang Soo Jang; Junghan Yoon; Wook Sung Chung; Jeong Gwan Cho; Ki Bae Seung; Seung Jung Park Journal: Yonsei Med J Date: 2009-12-29 Impact factor: 2.759