Genetic Polymorphisms and Perioperative Bleeding in Off-pump Coronary Artery Bypass Grafting Surgery.

BACKGROUND Clopidogrel use before coronary artery bypass grafting (CABG) may increase risk for perioperative hemorrhage. The effect of genetic polymorphisms related to clopidogrel responses on bleeding during or after off-pump CABG (OPCABG) is unknown. METHODS This prospective study included 206 coronary artery disease patients scheduled for OPCABG. Genotypes were determined using Sequenom MassARRAY system. Severe bleeding was defined by universal definition of perioperative bleeding in cardiac surgery. RESULTS Patients carrying the ABCB1 3435 wild-type genotype (CC) had a higher risk of severe perioperative bleeding compared with those carrying the variant genotype (CT or TT) (33.9% vs. 16.5%, P=0.009). Low baseline Hb level (OR=0.944, 95% CI: 0.917-0.972, P<0.001), low baseline eGFR (OR=0.977, 95% CI: 0.956-0.999, P=0.041), discontinuing clopidogrel ≤5 days prior to surgery (OR=2.458, 95% CI: 1.044-5.786, P=0.039), and the ABCB1 wild-type genotype (CC) (OR=2.941, 95% CI: 1.250-6.944, P=0.014) were independent risk factors for severe perioperative bleeding. CONCLUSIONS Patients carrying the ABCB1 wild-type genotype (CC) had a higher rate of severe perioperative bleeding compared with those carrying variant genotype (CT or TT). Discontinuation of clopidogrel ≤5 days prior to surgery and the ABCB1 wild-type genotype (CC) were independent risk factors for severe perioperative bleeding.