Coronary artery bypass grafting-related bleeding complications in patients treated with dual antiplatelet treatment

• Published in: European journal of cardio-thoracic surgery Vol. 50; no. 5; pp. 849 - 856
• Main Authors: Tomšič, Anton, Schotborgh, Mark A, Manshanden, Johan S J, Li, Wilson W L, de Mol, Bas A J M
• Format: Journal Article
• Language: English
• Published: Germany 01-11-2016
• Subjects: Adenosine - administration & dosage; Adenosine - adverse effects; Adenosine - analogs & derivatives; Aged; Aspirin - administration & dosage; Aspirin - adverse effects; Blood Transfusion - methods; Coronary Artery Bypass - adverse effects; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Postoperative Care - methods; Postoperative Hemorrhage - etiology; Preoperative Care - methods; Retrospective Studies; Ticlopidine - administration & dosage; Ticlopidine - adverse effects; Ticlopidine - analogs & derivatives; Antiplatelet drugs; Cardiac surgery; Blood transfusion; Coronary artery bypass grafting; Bleeding
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezw149

To evaluate the relationship between the timing of either ticagrelor or clopidogrel discontinuation and bleeding-related complications in patients undergoing isolated on-pump coronary artery bypass grafting (CABG).
Between January 2012 and December 2014, 705 consecutive patients underwent isolated on-pump CABG at our institution. Of these, 626 were eligible for this study. Surgery under acetylsalicylic acid (ASA) was performed in 404 patients (ASA group) and 222 patients underwent surgery under dual antiplatelet treatment (DAPT). Patients exposed to DAPT were stratified into the following groups: ticagrelor within 72 h prior to surgery (Group T ≤ 72, n = 63); ticagrelor within 72-120 h prior to surgery (Group T72-120, n = 21); clopidogrel within 120 h prior to surgery (Group C ≤ 120, n = 125); clopidogrel within 120-168 h prior to surgery (Group C120-168, n = 13).
Transfusion requirements in Group T ≤ 72 (72.1 vs 41.3%, P < 0.001) and Group C ≤ 120 (71.2 vs 41.3%, P < 0.001) were significantly higher compared with the ASA group. Multivariable analysis, comparing Group C ≤ 120, C120-168, T ≤ 72 and T72-120 with the ASA group, revealed Group C ≤ 120 and Group T ≤ 72 as predictors of bleeding-related complications. No increased incidence of bleeding-related complications was seen when ticagrelor was discontinued >72 h or clopidogrel >120 h prior to surgery.
Ticagrelor discontinuation >72 h and clopidogrel discontinuation >120 h prior to surgery were not associated with an increased risk of bleeding-related complications. Based on these findings, a period of ticagrelor discontinuation shorter than advised by current international guidelines might be justifiable.