Preoperative Clopidogrel Use and Its Effect on Postoperative Outcomes in CABG Patients: A Retrospective Cohort Study

Abstract

Objectives: To evaluate the impact of preoperative clopidogrel use on platelet transfusion requirements and postoperative outcomes in patients undergoing urgent or emergency coronary artery bypass grafting (CABG). Methodology: This retrospective observational study was conducted at the Cardiac Intensive Care Unit (CICU) of a tertiary care center in Pakistan between July 2022 and June 2023. Medical records of adult patients (aged 30–80 years) who underwent urgent or emergency CABG with cardiopulmonary bypass (CPB) were reviewed. Patients were divided into two groups: Group A included patients who had taken clopidogrel within five days before surgery, while Group B included those who either discontinued clopidogrel more than five days prior or did not receive it at all. Demographics, surgical details, and postoperative outcomes—including frequency of platelet transfusion, chest drain output, and CICU stay—were analyzed. Independent t-tests were used for continuous variables, and chi-square tests for categorical variables, with p < 0.05 considered statistically significant. Results: A total of 207 patients were analyzed (Group A: 106; Group B: 101). Group A required significantly more platelet transfusions (0.94 ± 2.29 vs. 0.32 ± 1.08 units; p = 0.01) and had a longer CICU stay (1.75 ± 1.02 vs. 1.45 ± 0.74 days; p = 0.01). Chest drain output showed no statistically significant difference between the groups (532.17 ± 203.80 vs. 558.27 ± 284.60 mL; p = 0.45). Clopidogrel use within five days preoperatively was significantly associated with increased transfusion needs and prolonged postoperative recovery. Conclusion: Preoperative use of clopidogrel within five days in patients undergoing urgent or emergency CABG is associated with a significantly higher need for platelet transfusions and longer CICU stays. These findings underscore the importance of optimizing antiplatelet management in high-risk cardiac surgery.