Effect of ticlopedin administration on mediastinal hemorrhage increase after off-pump coronary artery bypass surgery

Nowadays coronary surgery is done by means of cardiopulmonary pump (on-pump) or without using it (off-pump). Patients who undergo off-pump coronary artery bypass graft surgery (OPCAB) may be potentially hypercoagulable with an increased risk of graft thrombosis in their transplanted vessels. To counteract this complication and reduce ischemic events, antiplatelet drugs including ticlopedin is used in most therapeutic centres of the world. The purpose of this study was to determine the side effects of early ticlopedin administration after OPCAB. This clinical trial study was done on 300 patients admitted to cardiosurgical ward of Imam Reza hospital affiliated to Mashhad University of Medical Sciences between 2005 and 2007. Those clients whose postoperative drainage was less than 100cc/h were divided into two groups with 150 cases in each. The first group took ticlopedin for four weeks, but the second group (control) was not administered the drug. Aspirin was administered preoperatively and postoperatively to all patients. Telephone follow-up was made 6 to 12 months after being discharged. The obtained data was statistically analysed by means of 2 at the significant level P≤0.05. None of the patients in the first group required re-operation for mediastinal hemorrhage. Mean chest tube drainage was 1005±423 in ticlopedin group and 950±400 mL in patients who had not received ticlopedin. The total number of blood units transfused and the number of patients receiving blood transfusions was almost similar in the two groups. In-hospital mortality was 1.2% in ticlopedin group and 3.2% in the control group (P=0.314). No group difference in mortality or adverse cardiac events were observed during 6 months. Gastrointestinal bleeding occurred in 2.5% of ticlopedin patients but in 0.9% of the controls. The study showed that ticlopedin administration does not increase postoperative mediastinal hemorrhage.