Plavix more than doubles take back for bleeding rate
There was an interesting article on bleeding after heart surgery in the American Heart Journal this month. The Title is “Clopidogrel loading dose and bleeding outcomes in patients undergoing urgent coronary artery bypass grafting.” The Citation is: Am Heart J 2011 Feb;161(2):404-10.
The focus of the study is the impact of Plavix (Clopidogrel) on bleeding after heart surgery. The investigators found that major bleeding happened in 73% of patients loaded with a higher dose of Plavix (clopidogrel), and 47% of those on a lower maintenance dose. The take back for bleeding rate was 12% vs 5% in the Plavix group vs. those without Plavix. One might say that you should hold off for 5 days before you operate on patients taking Plavix, but many surgeons report they find this is difficult for patients requiring urgent coronary bypass. The result is that as many as three quarters of these patients have major bleeding, many ending up back in the operating room that night for a wash out. Most are never found to have surgical sites of bleeding, just clotted chest tubes and blood around the heart that needs to be washed out. The morbidity, mortality and costs go up considerably for these patients. We are hearing that many think this is an optimal indication for PleuraFlow® to help reduce the take back rate and lessen the time in the ICU, etc. Most of these patients are simply oozing, not bleeding from surgical sources that require reoperation, and will stop bleeding when the platelets are replaced in the ICU post op. If the chest tubes clog during this critical period, blood will build up around the heart, the blood pressure will drop, and the team is called in to take the patient back to the operating room. We are hearing from surgeons who think a number of these take backs can be prevented if the chest tubes stay open and draining and the patient remains stable while the platelets and the blood is replaced in the first 4 to 8 hours post op. If the tubes clog, however, they have to go back urgently to the OR that night (The take back for bleeding). Thus the Plavix patient requiring urgent surgery (not an uncommon scenario) is turning out to be a common indication for PleuraFlow® where the Active Tube Clearance® system can be used to keep the tubes open while the platelets are replaced and the bleeding stops.