Aspirin plus clopidogrel and risk of infection after coronary artery bypass surgery

Elena Blasco-Colmenares, Trish M. Perl, Eliseo Guallar, William A. Baumgartner, John V. Conte, Diane Alejo, Roberto Pastor-Barriuso, A. Richey Sharrett, Nauder Faraday

Research output: Contribution to journalArticle

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Abstract

Background: The risks associated with the use of the combination of aspirin and clopidogrel before surgery are incompletely understood. Pharmacologic suppression of platelet function may increase the risk of postoperative infection by inhibiting hemostasis, immunity, or both. Methods: We performed a retrospective cohort study of 1677 patients undergoing coronary artery bypass surgery to determine the relationship of the preoperative use of aspirin plus clopidogrel vs aspirin alone to the 30-day incidence of postoperative surgical site infection and bacteremia. Results: The cumulative incidence of infection at 30 days was 23.1% and 16.1% in patients who were receiving dual antiplatelet therapy and aspirin monotherapy, respectively (unadjusted hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.09-2.08). The risk of infection remained higher among patients who were receiving dual antiplatelet therapy after adjustment for demographic, socioeconomic, preoperative, and intraoperative risk factors (HR, 1.42; 95% CI, 1.01-2.00) and propensity score (HR, 1.43; 95% CI, 1.01-2.01]). Transfusion rates were also higher among patients who were receiving dual antiplatelet therapy than among patients who were receiving aspirin monotherapy (68.4% vs 60.4%, P=.04), but transfusion played a modest role in mediating the risk of infection (adjusted HR, 1.37; 95% CI, 0.96-1.93]). Mortality rates at 30 days were 5.2% and 3.1% in patients who were receiving dual antiplatelet and aspirin monotherapy, respectively (adjusted HR, 1.44; 95% CI, 0.70-2.99]). Conclusions: Preoperative use of aspirin plus clopidogrel is associated with an increased risk of infection after coronary artery bypass surgery. These findings merit additional work to clarify the risks and benefits of uninterrupted dual antiplatelet therapy in surgical patients and the impact of platelet inhibition on infectious outcomes in populations that are at heightened infectious risk.

Original languageEnglish (US)
Pages (from-to)788-796
Number of pages9
JournalArchives of Internal Medicine
Volume169
Issue number8
DOIs
StatePublished - Apr 27 2009

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clopidogrel
Coronary Artery Bypass
Aspirin
Infection
Confidence Intervals
Blood Platelets
Surgical Wound Infection
Propensity Score
Incidence
Therapeutics
Bacteremia
Hemostasis
Immunity
Cohort Studies

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Blasco-Colmenares, E., Perl, T. M., Guallar, E., Baumgartner, W. A., Conte, J. V., Alejo, D., ... Faraday, N. (2009). Aspirin plus clopidogrel and risk of infection after coronary artery bypass surgery. Archives of Internal Medicine, 169(8), 788-796. https://doi.org/10.1001/archinternmed.2009.42
Blasco-Colmenares, Elena ; Perl, Trish M. ; Guallar, Eliseo ; Baumgartner, William A. ; Conte, John V. ; Alejo, Diane ; Pastor-Barriuso, Roberto ; Sharrett, A. Richey ; Faraday, Nauder. / Aspirin plus clopidogrel and risk of infection after coronary artery bypass surgery. In: Archives of Internal Medicine. 2009 ; Vol. 169, No. 8. pp. 788-796.
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abstract = "Background: The risks associated with the use of the combination of aspirin and clopidogrel before surgery are incompletely understood. Pharmacologic suppression of platelet function may increase the risk of postoperative infection by inhibiting hemostasis, immunity, or both. Methods: We performed a retrospective cohort study of 1677 patients undergoing coronary artery bypass surgery to determine the relationship of the preoperative use of aspirin plus clopidogrel vs aspirin alone to the 30-day incidence of postoperative surgical site infection and bacteremia. Results: The cumulative incidence of infection at 30 days was 23.1{\%} and 16.1{\%} in patients who were receiving dual antiplatelet therapy and aspirin monotherapy, respectively (unadjusted hazard ratio [HR], 1.51; 95{\%} confidence interval [CI], 1.09-2.08). The risk of infection remained higher among patients who were receiving dual antiplatelet therapy after adjustment for demographic, socioeconomic, preoperative, and intraoperative risk factors (HR, 1.42; 95{\%} CI, 1.01-2.00) and propensity score (HR, 1.43; 95{\%} CI, 1.01-2.01]). Transfusion rates were also higher among patients who were receiving dual antiplatelet therapy than among patients who were receiving aspirin monotherapy (68.4{\%} vs 60.4{\%}, P=.04), but transfusion played a modest role in mediating the risk of infection (adjusted HR, 1.37; 95{\%} CI, 0.96-1.93]). Mortality rates at 30 days were 5.2{\%} and 3.1{\%} in patients who were receiving dual antiplatelet and aspirin monotherapy, respectively (adjusted HR, 1.44; 95{\%} CI, 0.70-2.99]). Conclusions: Preoperative use of aspirin plus clopidogrel is associated with an increased risk of infection after coronary artery bypass surgery. These findings merit additional work to clarify the risks and benefits of uninterrupted dual antiplatelet therapy in surgical patients and the impact of platelet inhibition on infectious outcomes in populations that are at heightened infectious risk.",
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Blasco-Colmenares, E, Perl, TM, Guallar, E, Baumgartner, WA, Conte, JV, Alejo, D, Pastor-Barriuso, R, Sharrett, AR & Faraday, N 2009, 'Aspirin plus clopidogrel and risk of infection after coronary artery bypass surgery', Archives of Internal Medicine, vol. 169, no. 8, pp. 788-796. https://doi.org/10.1001/archinternmed.2009.42

Aspirin plus clopidogrel and risk of infection after coronary artery bypass surgery. / Blasco-Colmenares, Elena; Perl, Trish M.; Guallar, Eliseo; Baumgartner, William A.; Conte, John V.; Alejo, Diane; Pastor-Barriuso, Roberto; Sharrett, A. Richey; Faraday, Nauder.

In: Archives of Internal Medicine, Vol. 169, No. 8, 27.04.2009, p. 788-796.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Aspirin plus clopidogrel and risk of infection after coronary artery bypass surgery

AU - Blasco-Colmenares, Elena

AU - Perl, Trish M.

AU - Guallar, Eliseo

AU - Baumgartner, William A.

AU - Conte, John V.

AU - Alejo, Diane

AU - Pastor-Barriuso, Roberto

AU - Sharrett, A. Richey

AU - Faraday, Nauder

PY - 2009/4/27

Y1 - 2009/4/27

N2 - Background: The risks associated with the use of the combination of aspirin and clopidogrel before surgery are incompletely understood. Pharmacologic suppression of platelet function may increase the risk of postoperative infection by inhibiting hemostasis, immunity, or both. Methods: We performed a retrospective cohort study of 1677 patients undergoing coronary artery bypass surgery to determine the relationship of the preoperative use of aspirin plus clopidogrel vs aspirin alone to the 30-day incidence of postoperative surgical site infection and bacteremia. Results: The cumulative incidence of infection at 30 days was 23.1% and 16.1% in patients who were receiving dual antiplatelet therapy and aspirin monotherapy, respectively (unadjusted hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.09-2.08). The risk of infection remained higher among patients who were receiving dual antiplatelet therapy after adjustment for demographic, socioeconomic, preoperative, and intraoperative risk factors (HR, 1.42; 95% CI, 1.01-2.00) and propensity score (HR, 1.43; 95% CI, 1.01-2.01]). Transfusion rates were also higher among patients who were receiving dual antiplatelet therapy than among patients who were receiving aspirin monotherapy (68.4% vs 60.4%, P=.04), but transfusion played a modest role in mediating the risk of infection (adjusted HR, 1.37; 95% CI, 0.96-1.93]). Mortality rates at 30 days were 5.2% and 3.1% in patients who were receiving dual antiplatelet and aspirin monotherapy, respectively (adjusted HR, 1.44; 95% CI, 0.70-2.99]). Conclusions: Preoperative use of aspirin plus clopidogrel is associated with an increased risk of infection after coronary artery bypass surgery. These findings merit additional work to clarify the risks and benefits of uninterrupted dual antiplatelet therapy in surgical patients and the impact of platelet inhibition on infectious outcomes in populations that are at heightened infectious risk.

AB - Background: The risks associated with the use of the combination of aspirin and clopidogrel before surgery are incompletely understood. Pharmacologic suppression of platelet function may increase the risk of postoperative infection by inhibiting hemostasis, immunity, or both. Methods: We performed a retrospective cohort study of 1677 patients undergoing coronary artery bypass surgery to determine the relationship of the preoperative use of aspirin plus clopidogrel vs aspirin alone to the 30-day incidence of postoperative surgical site infection and bacteremia. Results: The cumulative incidence of infection at 30 days was 23.1% and 16.1% in patients who were receiving dual antiplatelet therapy and aspirin monotherapy, respectively (unadjusted hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.09-2.08). The risk of infection remained higher among patients who were receiving dual antiplatelet therapy after adjustment for demographic, socioeconomic, preoperative, and intraoperative risk factors (HR, 1.42; 95% CI, 1.01-2.00) and propensity score (HR, 1.43; 95% CI, 1.01-2.01]). Transfusion rates were also higher among patients who were receiving dual antiplatelet therapy than among patients who were receiving aspirin monotherapy (68.4% vs 60.4%, P=.04), but transfusion played a modest role in mediating the risk of infection (adjusted HR, 1.37; 95% CI, 0.96-1.93]). Mortality rates at 30 days were 5.2% and 3.1% in patients who were receiving dual antiplatelet and aspirin monotherapy, respectively (adjusted HR, 1.44; 95% CI, 0.70-2.99]). Conclusions: Preoperative use of aspirin plus clopidogrel is associated with an increased risk of infection after coronary artery bypass surgery. These findings merit additional work to clarify the risks and benefits of uninterrupted dual antiplatelet therapy in surgical patients and the impact of platelet inhibition on infectious outcomes in populations that are at heightened infectious risk.

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