Plasma sequestration: a good therapy to prevent the deleterious effect of clopidogrel when clopidogrel is used within one to four days of coronary bypass surgery

Abstract

Clopidogrel (Plavix) is an inhibitor of ADP-induced platelet aggregation, acting by direct inhibition of adenosine diphosphate (ADP) binding to its receptor and of the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex. A common recommendation for coronary artery bypass surgery is to stop clopidogrel five to seven days before surgery.(1) Patients taking clopidogrel within five days of surgery are more likely to show an increase in post-operative bleeding, an increase need for blood products, and an increased chance for secondary operations to control bleeding. This paper presents an option which appears to decrease the adverse effects of clopidogrel for patients undergoing coronary artery bypass surgery within one to four days of stopping the use of clopidogrel. This option is autologous plasma sequestration. The process of plasma sequestration collection prior to the administration of heparin during surgery offers a significant therapy to minimize bleeding post bypass. Twelve consecutive patients are included in this study (one a REDO) each receiving clopidogrel within one to four days of surgery. Throughout their hospital stay, three patients required packed red blood cell (RBC) transfusions (two received 2 units, one received 1 unit). No other donor blood products were required. Post-operative bleeding was minimal, and the need for a secondary operation due to bleeding was eliminated. The average stay in the cardiovascular intensive care unit(CICU) was 2.8 days, with an average hospital stay of 7.25 days.