Effect of time of discontinuing clopidogrel administration before operation on blood-saving effect of tranexamic acid

Abstract

Objective To evaluate the effect of time of discontinuing clopidogrel administration before operation on blood-saving effect of tranexamic acid. Methods One hundred and eighty patients of both sexes, aged 18-70 yr, weighing 45-85 kg, scheduled for elective first coronary artery bypass grafting under cardiopulmonary bypass, were divided into A, B and C groups (n=60 each) according to clopidogrel use before operation. In group A, clopidogrel 75 mg/d was taken orally, and time of stopping clopidogrel administration before operation <7 days.In group B, clopidogrel 75 mg/d was taken orally, and time of stopping use of clopidogrel before operation ≥7 days.Patients received no clopidogrel before operation in group C. After induction of anesthesia, tranexamic acid was infused at a loading dose of 10 mg/kg over 20 min, followed by an infusion of 10 mg·kg-1·h-1 until the end of operation.Blood loss and requirement for allogeneic erythrocytes, plasma and platelet were recorded before removal of drainage tubes after operation.The dose of heparin and protamine was recorded.The development of perioperative adverse reactions was also recorded. Results There was no significant change in the amount of heparin and protamine, ratio of protamine to heparin for heparin neutralization or incidence of perioperative adverse reactions between the three groups (P>0.05). Compared with group C, the incidence of major bleeding, transfusion of and requirement for allogeneic erythrocytes, plasma and platelets were significantly increased in group A (P 0.05). There was no significant difference in postoperative blood loss or transfusion of allogeneic erythrocytes, plasma and platelets between group B and group A (P>0.05). Conclusion The time of discontinuing clopidogrel administration before operation exerts no effect on blood-saving effect of tranexamic acid. Key words: Platelet aggregation inhibitors; Tranexamic acid; Blood transfusion