Benefits and risks of using clopidogrel before coronary artery bypass surgery: Systematic review and meta-analysis of randomized trials and observational studies
The Journal of Thoracic and Cardiovascular Surgery,  Evidence Based Medicine  Clinical Article

Biancari F et al. – Contrary to the findings of post hoc analyses of randomized trials, observational studies showed that recent exposure to clopidogrel before coronary artery bypass grafting is associated with increased risk of postoperative death, reoperations for bleeding, blood loss, and need of blood transfusions.

Methods
  • A systematic literature search was performed to identify studies on the use of clopidogrel before coronary artery bypass grafting.
  • Meta-analysis was performed according to the Cochrane Handbook for Systematic Reviews.

Results
  • The literature search yielded 3 prospective randomized studies and 17 observational studies with valid data.
  • Randomized studies were post hoc analyses of the Clopidogrel as Adjunctive Reperfusion Therapy (CLARITY), Clopidogrel for the Reduction of Events During Observation (CREDO), and Clopidogrel in Unstable Angina to Prevent Recurrent Ischemic Events trials.
  • Meta-analysis based on these data showed a nonsignificant reduced risk of immediate postoperative composite end point (death, myocardial infarction, or stroke) in the clopidogrel group (risk ratio [RR], 0.77; 95% confidence interval [CI], 0.58–1.04).
  • Data from the CREDO and CLARITY trials showed a similar risk of death (RR, 0.81; 95% CI, 0.20–3.37), myocardial infarction (RR 0.58; 95% CI, 0.25–1.33), and major bleeding according to Thrombolysis in Myocardial Infarction criteria (RR, 1.48; 95% CI, 0.72–3.04).
  • Meta-analysis of observational studies showed that preoperative exposure to clopidogrel was associated with an increased risk of death (RR, 1.30; 95% CI, 1.02–1.67), reoperation for bleeding (RR, 1.88; 95% CI, 1.37–2.58), blood loss (mean difference, 157.8 mL; 95% CI, 61.9–253.6), need of packed red blood cell transfusion (RR, 1.23; 95% CI, 1.10–1.37), and increased use of blood products.
  • A significantly reduced risk of postoperative myocardial infarction was observed among patients taking clopidogrel (RR, 0.63; 95% CI, 0.48–0.82).

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

    Currently, there are no available articles.

Your Unread Messages in Pharmacy

See All >> Messages include industry-sponsored communications and special communications from MDLinx

<

Most Popular Pharmacy Articles

Indexed Journals in Pharmacy: Expert Opinion in Pharmacotherapy, Formulary, U.S.Pharmacistmore

Make smarter career moves with less time.

Sign up for our free job placement service today and have a dedicated career consultant help locate the right physician job for you!
Click Here for more information.

Get Started Now!

Free-of-charge, no obligation.

Terms and Conditions For M3 Career Consult

By registering with the M3 Career Consult service you authorize M3 USA Corporation to represent you in your job search. The following is a summary of the terms of our service and our mutual obligations to help you find a job:

  • You designate M3 to act as your agent and represent you in your job search;
  • You will not pay us for this service
  • You will advise us of any companies or positions to which you apply or have applied;
  • You will advise us if you believe you are not capable of performing a position for which we submit you, or for which you interview;
  • You will keep all information we provide you about companies or positions strictly confidential;
  • You will promptly provide us with information we request of you;
  • You will make yourself reasonably available for phone, video and in-person conversations and interviews;
  • You will be truthful in all of your communications with us; and
  • You will advise us if anything above changes.
 

The Top Read Articles of 2014 are Now Available

Scouring thousands of peer-reviewed journals and popular press, Our Editors just released the Top Read Articles of the Year. See the Top Read List