Evidence map›Paper›PMID 28222991›Full record

ArticleJournal of vascular surgery2017

Perioperative clopidogrel is associated with increased bleeding and blood transfusion at the time of lower extremity bypass.

Douglas W Jones, Marc L Schermerhorn, Benjamin S Brooke, Mark F Conrad, Philip P Goodney, Mark C Wyers, David H Stone, Vascular Quality Initiative

Registry-linked trialOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of vascular surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03115346 (Alignment of Treatment Preferences and Repair Type for Veterans With AAA), which is not on this map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
1.1field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03115346 nacompletednot on this map

Alignment of Treatment Preferences and Repair Type for Veterans With AAA

TypeinterventionalSponsorVA Office of Research and DevelopmentRan2017 to 2022Enrolled241ConditionsAbdominal Aortic AneurysmArmsDecision aid
3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

  1. Pooled it
  2. Observational
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Douglas W JonesDepartment of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
Marc L SchermerhornDepartment of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
Benjamin S BrookeSection of Vascular Surgery, The University of Utah School of Medicine, Salt Lake City, Utah.
Mark F ConradDepartment of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
Philip P GoodneySection of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH.
Mark C WyersDepartment of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
David H StoneSection of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: david.h.stone@hitchcock.org.
Vascular Quality Initiative
Dartmouth–Hitchcock Medical Center · USDartmouth Institute for Health Policy and Clinical Practice · USMassachusetts General Hospital · USUniversity of Utah · US

Funding

Creating National Surveillance Infrastructure for Priority Medical DevicesU01FD005478 · FDA · WEILL MEDICAL COLL OF CORNELL UNIV · PI SEDRAKYAN, ART · 2015 to 2019
$6.5M
FDA HHS U01 FD005478
6 · The paper itself

Abstract

objectiveControversy persists surrounding the perceived bleeding risk associated with perioperative clopidogrel use in patients undergoing lower extremity bypass (LEB). The purpose of this study was to examine the LEB bleeding risk and clinical sequelae associated with clopidogrel.

methodsAll LEBs in the Vascular Quality Initiative (VQI) from 2008 to 2014 were studied. The exposure was perioperative clopidogrel. Primary outcomes were blood transfusion, estimated blood loss ≥500 mL, and reoperation for bleeding. Secondary outcomes included mean operative time, major cardiac events, respiratory complications, infectious complications, and in-hospital mortality. Univariate and multivariable analyses were used to analyze patients on the basis of clopidogrel use and its association with outcomes. Nonparametric test for trend and Mantel-Haenszel methods were used to analyze association of clopidogrel use with blood transfusion and secondary outcomes.

resultsAmong the LEB cohort (N = 9179), 28% (n = 2544) were taking clopidogrel and 72% (n = 6635) were not. Patients taking clopidogrel were more likely to have coronary disease, prior coronary intervention, abnormal findings on stress test, and aspirin use (P < .001 for all). Patients taking clopidogrel were more likely to receive blood transfusion (38% vs 24%; P < .001) and to have estimated blood loss ≥500 mL (21% vs 12%; P < .001). Reoperation for bleeding rates were similar (0.9% vs 1.1%; P = .9). Clopidogrel use was also associated with increased mean operative times (244 minutes vs 232 minutes; P < .001) as well as with cardiac complications (8.8% vs 6.5%; P = .001), respiratory complications (2.5% vs 1.6%; P = .007), and in-hospital mortality (1.3% vs 0.8%; P = .03). Multivariable analysis demonstrated that clopidogrel was associated with increased risk of 1- or 2-unit blood transfusion (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.5-2.1; P < .001) and >2-unit blood transfusion (OR, 2.0; 95% CI, 1.7-2.5; P < .001). Major cardiac events (OR, 1.2; 95% CI, 1.0-1.5; P = .05) and respiratory complications (OR, 1.4; 95% CI, 1.0-2.0; P = .03) were also independently associated with clopidogrel use. Weighted Mantel-Haenszel ORs controlling for blood transfusion amount revealed no remaining effect of clopidogrel on major cardiac events (OR, 1.1; P = .4) or respiratory complications (OR, 1.0; P = .8).

conclusionsPerioperative clopidogrel use in LEB surgery is associated with increased blood loss and blood transfusion. Associated clinical sequelae include increased cardiac and pulmonary complications. Accordingly, surgeons should consider discontinuation of perioperative clopidogrel when it is clinically appropriate unless it is strongly indicated at the time of LEB.

Indexed as

Blood Loss, SurgicalBlood TransfusionAgedChi-Square DistributionClopidogrelDatabases, FactualDrug Administration ScheduleFemaleHospital MortalityHumansLogistic ModelsLower ExtremityMaleMiddle AgedMultivariate AnalysisOdds RatioClopidogrelPlatelet Aggregation InhibitorsTiclopidine

Identifiers

PMID28222991
PMCPMC6114130
OpenAlexW2589723429

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.