Risk factors of major bleeding in patients undergoing off-pump coronary artery bypass grafting

Objective To identify the risk factors of major bleeding in patients undergoing off-pump coronary artery bypass grafting(OPCAB). Methods Data on coronary artery disease patients who underwent off-pump CABG between December 2009 and December 2014 were reviewed. Baseline characteristics were compared between patients with clopidogrel discontinuation ≥5 days and <5 days. Univariate and multivariate logistic regression analyses were performed to investigate the risk factors of perioperative major bleeding. Major bleeding was defined as the Universal Definition of Perioperative Bleeding(UDPB) class 3-4. Results A total of 3 988 patients who underwent OPCAB were included in this study. Major bleeding rate was 9.23%(n=368). Multivariable regression analysis showed that female sex(OR=1.99, 95%CI: 1.57-2.52), age(OR=1.02, 95%CI: 1.00-1.03), lower BMI(BMI≤25 kg/m2)(OR=1.40, 95%CI: 1.12-1.75), decreased GRF(GFR<60 ml/min)(OR=1.43, 95%CI: 1.01-2.02), decreased preoperative Hct(Hct<0.40)(OR=1.57, 95%CI: 1.23-1.99) and clopidogrel discontinuation <5 days(OR=1.97, 95%CI: 1.58-2.44) conferred a higher risk of perioperative major bleeding during OPCABG. Conclusion Female, advanced age, lower BMI, decreased GRF, decreased preoperative Hct and clopidogrel discontinuation<5 days are independent risk factors of perioperatice major bleeding in patients undergoing OPCAB. Predicting risk of major bleeding can help sugeons to optimize perioperative management. Key words: Coronary artery bypass grafting, off pump Risk factors Perioperative Bleeding