In patients with acute coronary syndromes, short-term use of clopidogrel (Plavix) and aspirin reduces ischemic events. But these drugs also increase the risk of bleeding in patients who need surgery. Assessing the risk in patients undergoing coronary artery bypass graft (CABG) surgery, researchers found that clopidogrel use within 5 days before CABG surgery "was not significantly associated with reoperation for bleeding[horizontal ellipsis] and only weakly with red cell transfusion after surgery." They based their findings on an analysis of bleeding events among 4,794 patients undergoing CABG surgery.

Researchers caution clinicians that a decision about whether or not to withhold clopidogrel in a patient who's benefited from the drug should be made in the context of other bleeding determinants, such as the use of cardiopulmonary bypass during surgery.

Source: Kim JH, Newby LK, Clare RM, et al. Clopidogrel use and bleeding after coronary artery bypass graft surgery. Am Heart J. 2008;156(5):886-892.