Cardiothoracic & vascular anesthesia
New-onset postoperative atrial fibrillation and burden imposed by CYP2C19 metabolizer phenotype on clopidogrel in off-pump coronary artery bypass: a retrospective cohort study
Authors' conclusion
The weaker CYP2C19 metabolizer phenotype was at the risk of developing POAF after OPCABG surgery with oral clopidogrel regimen.
Study context
- Population
- Patients undergoing elective first-time off-pump coronary artery bypass graft (OPCABG) receiving 100 mg/day aspirin and 75 mg/day clopidogrel, May 2017 to November 2023
- Participants
- 320 patients
- Exposure
- CYP2C19 intermediate or poor metabolizer vs normal metabolizer phenotype on clopidogrel
- Normal metabolizer (NM)n = 163reference
- Intermediate metabolizer (IM)n = 112
- Poor metabolizer (PM)n = 45
- Outcome
- New-onset POAF
- Follow-up
- First week
Main finding
As reported in the abstract
Incidence of POAF
Each group vs NMHazard ratio (95% CI)P value
IM
1.843(1.155–2.940)
P = 0.0076PM
3.363(1.753–6.499)
P < 0.0001Observational data: associations, not effects.
Further findings
Interleukin-6 · 5 days after OPCABG
D-dimer · 5 days after OPCABG
Postoperative hospital stay
| Outcome | NM | IM | PM |
|---|---|---|---|
| ADP-stimulated platelet aggregation · 5 days after OPCABG | 17.8% ± 4.4% | 27.8% ± 4.3% | 37.2% ± 5.8% |
| POAF burden | 3.0% (interval 1.2%–6.1%) | 4.8% (interval 2.4%–11.9%) | 8.9% (interval 4.8%–17.4%) |
- ADP-stimulated platelet aggregation: F = 367.594, P < 0.001
- Interleukin-6: F = 8.471, P < 0.001
- D-dimer: F = 37.61, P < 0.001
- Postoperative atrial fibrillation (POAF) burden: P < 0.001
- Postoperative hospital stay: P = 0.004
Original publication
New-onset postoperative atrial fibrillation and burden imposed by CYP2C19 metabolizer phenotype on clopidogrel in off-pump coronary artery bypass: a retrospective cohort study. Perioper Med (Lond). Published 2 October 2025. doi:10.
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