Pre-operative strategies on clopidogrel use in coronary artery bypass grafting

There is a lack of standards pertaining to stopping antiplatelet agents in patients with acute coronary syndromes prior to coronary surgery. We conducted a national survey of all centres performing cardiac surgery in the UK and Ireland into practices and standards in relation to clopidogrel and aspirin before coronary artery surgery (n=36).
The response rate was 89%. The majority of centres used combination antiplatelet therapy in either some or all pre-operative acute coronary syndrome patients (79%). Aspirin alone is given in 19% of this surgical subpopulation. Aspirin is stopped 4.9 + 0.5 days (mean + SEM) and clopidogrel 6.5 + 0.5 days prior to surgery. There are no clear departmental policies in most cases (21 of 32 units) regarding cessation of clopidogrel. A subjective increase in bleeding was reported in 69% of centres; in 15 centres (47%) patients had returned to theatre for bleeding.
Many units in the UK still do not have a policy regarding antiplatelet therapy in those patients with acute coronary syndromes who are awaiting coronary bypass surgery. A randomised controlled trial is probably the correct way of evaluating the best strategy on use and omission of aspirin and clopidogrel in this setting.