Importancia del tiempo de suspensión del uso combinado de aspirina y clopidogrel en pacientes sometidos a cirugía de revascularización coronaria

SummaryI MPORTANCE OF THE TIME FOR STOPPING THE COMBINEDUSE OF ASPIRIN AND CLOPIDOGREL IN PATIENTSUNDERGOING CORONARY ARTERY BY - PASS GRAFTSURGERY The combined use of aspirin and clopidogrel isthe standard of care for patients with acute coro-nary syndromes. The risk for perioperative bleed-ing is considerably increased after coronary ar-tery by-pass graft surgery (CABG). This study wasdesigned to evaluate the effect of antiplatelet ther-apy on perioperative CABG outcome. We stud-ied 49 consecutive patients undergoing first timeCABG, and compared two groups: Group A, pa-tients who stopped antiplatelet treatment at least6 days before surgery, and group B, those whoreceived antiplatelet therapy within 5 days be-fore surgery or did not suspended therapy. Thegroups were comparable in their demographiccharacteristics, manifestations of disease, perio-perative medication use and the characteristicsof surgery. There was a non significant tendencyfor more cardiovascular complications (primarycardiovascular endpoint) in the group that stoppedantiplatelet therapy 6 or more days before sur-gery (Group A 12%, group B 8%; p = 0.923). Thebleeding endpoint was significantly higher ingroup B, that remained on antiplatelet therapywithin 5 days before surgery (Group A 4%, groupB 29%; p = 0.023), as well as the need for transfu-sion. We concluded that the combined use of as-pirin and clopidogrel before CABG increases post-operative bleeding and morbidity; there was nodefinitive difference in the cardiovascular outcome.(Arch Cardiol Mex 2008; 78: 178-186)