The Effect Of Clopidogrel On The Perioperative Safety Of Patients Undergoing Off-pump Coronary Artery Bypass Grafting (OPCABG)

Objective: To investigate the effect of stopping time of clopidazole before off-pump coronary artery bypass grafting(OPCABG)on perioperative bleeding and postoperative outcome,so as to provide more safe perioperative guidance for patients undergoing vein bypass grafting.Methods: 180 patients who undergone OPCABG in the Second Hospital of Hebei Medical University from February 2017 to December 2017 were selected and divided into three groups according to the time of stopping clopidogrel before operation: 60 cases of <3d group(Group 1),60 cases of3-5 group(Group 2)and 60 cases of >5d group(Group 3).Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),BIS,heart rate(HR),central venous pressure(CVP)and related hemodynamic parameters were monitored and recorded continuously after patients entering the room.The blood loss during operation,blood transfusion during and after operation,drainage flow after 24 hours,extubation time,awake time,ICU stay days and hospitalization days of the three groups were recorded,and then we got the conclusion finally.Results:1.There was no statistically significant difference in age,weight,operation time,bypass count,risk factors of coronary heart disease,post-operative outcome and so on between the group of stopping time of <3d,3-5 and >5d.(P>0.05)2.The intraoperative blood loss and autologous blood recovery in <3 d group,3-5 d group and >5d were compared,the contrast difference between<3 d group and 3-5 d group is statistically significant,the intraoperative blood loss and autologous blood recovery in <3 d group were significantly higherthan those in>5d group.3.There was no statistically significant difference in red blood cell transfusion,platelet transfusion and cold precipitation in <3d group,3-5d group and >5d group,but there was statistically significant difference in plasma transfusion volume and transfusion rate between <3d group and other two groups(P<0.05),plasma transfusion volume and transfusion rate in <3d group increased significantly4.There was significant difference in 24 h postoperative drainage between >5d group and other groups(P<0.05).24 h postoperative drainage in >5d group was less than that in other groups5.There was no statistically significant difference in cold precipitation and platelet transfusion between <3d group,3-5 group and >5d group(P>0.05).RBC and plasma transfusion volume and transfusion rate in <3d group were significantly higher than those in >5d group(P<0.05).RBC and plasma transfusion volume and transfusion rate in <3d group were significantly increasing.6.There was no statistically significant difference among the three groups in four postoperative outcome indicators: postoperative wake up time,extubation time and ICU stay time and hospitalization time in <3d group,3-5group and >5d group.(P>0.05)Conclusion:1.The patients who stopped clopidogrel for 3-5 before OPCABG only increased the 24 h drainage flow after operation compared with those who stopped clopidogrel for >5d,but still in the scope of control and did not affect the safety and outcome of operation.Clopidogrel could be stopped at 3-5 days before operation.2.Continuous application of antiplatelet clopidogrel to OPCABG patients before operation did not seriously affect the postoperative outcome of patients within 3 days before operation,but it could lead to increased incidence of perioperative bleeding and significant increase of allogeneic blood input.Cardiovascular events and bleeding risks should be consideredcomprehensively before emergency C A B G for high-risk patients.