Incidence of Re-Exploration for Bleeding Following OPCABG Patient Continuing DAPT (Aspirin and Clopidogrel)

Author(s): Mohammad Samir Azam Sunny, Ashiqur Rahman, Amirul Islam, Noor-E-Elahi Mozumder, Qazi Tazkia Ara

Background: Patients with coronary artery disease (CAD), off-pump coronary artery bypass grafting (OPCABG) is becoming more and more popular to avoid the problems that come with cardiopulmonary bypass. Using dual antiplatelet treatment (DAPT) during surgery, typically involving Aspirin and a P2Y12 inhibitor like Clopidogrel, can be difficult because it may increase bleeding and require additional surgery, which can lead to morbidities and consume resources.

Objective: The goal is to evaluate how often patients who have OPCABG and are taking DAPT (aspirin and clopidogrel) experience bleeding that requires further surgery during the time around their operation.

Methods: At a tertiary-level hospital 289 patients who had OPCABG surgery and continued taking DAPT before and after the procedure from January 2019 to December 2024. We gathered data on operations, clinical conditions, and results.

Results: In 5.88% (17/289) of patients, re-exploration for bleeding took place. The following were significant predictors: BMI ≥30 kg/m² (OR 2.1), chronic renal disease (CKD) (OR 2.8), and intraoperative blood loss >600 mL (OR 3.2). The postoperative hemoglobin levels were lower in patients undergoing re-exploration, and their drain output and transfusion equirements were higher. Despite higher morbidity, there was no obvious difference in death between patients who had undergone re-exploration and those who had not.

Conclusion: In selected patients, continuing DAPT after OPCABG leads to a low rate of needing further surgery, similar to ONCABG without DAPT, showing that it is safe. Comorbid conditions like CKD and obesity raise the risk of bleeding.