Vorobcsuk et al. have published an interesting large meta-analysis of observational studies in patients undergoing cardiac surgery.
The authors measured the impact of clopidogrel therapy on clinical outcomes such as the rate of red blood cell (RBC) transfusions, the need for reoperation, myocardial infarction and postoperative mortality. Twenty studies comprising a total number of 23,668 patients were analyzed. The main result is striking: the administration of clopidogrel was associated with a higher risk for postoperative mortality (OR: 1.24; 95% CI: 1.031.49, p=0.03). In addition, exposure of patients to clopidogrel was also associated with a significantly higher rate of RBC transfusion and reoperation. The mortality and the rate of transfusions were higher in studies in which clopidogrel was not discontinued 5 days prior to surgery. These data have to be understood as a signal, as they are supported by non-randomized studies. The 5-days’ delay should be considered in this fragile patient population.

– Charles-Marc Samama