Bleeding in Patients Treated With Ticagrelor or Clopidogrel Before Coronary Artery Bypass Grafting




Manne Holm, Fausto Biancari, Sorosh Khodabandeh, Riccardo Gherli, Juhani Airaksinen, Giovanni Mariscalco, Giuseppe Gatti, Daniel Reichart, Francesco Onorati, Marisa De Feo, Giuseppe Santarpino, Antonino S. Rubino, Daniele Maselli, Francesco Santini, Francesco Nicolini, Marco Zanobini, Eeva-Maija Kinnunen, Vito G. Ruggieri, Andrea Perrotti, Stefano Rosato, Magnus Dalén

PublisherElsevier USA

2019

Annals of Thoracic Surgery

Annals of Thoracic Surgery

Ann Thorac Surg

107

6

1690

1698

9

0003-4975

00034975

DOIhttps://doi.org/10.1016/j.athoracsur.2019.01.086

https://research.utu.fi/converis/portal/detail/Publication/41612684



Background

We evaluated perioperative bleeding after coronary artery bypass grafting (CABG) in patients preoperatively treated with ticagrelor or clopidogrel, stratified by discontinuation of these P2Y12 inhibitors.

Methods

All
patients from the prospective, European Multicenter Registry on
Coronary Artery Bypass Grafting (E-CABG) treated with ticagrelor or
clopidogrel undergoing isolated primary CABG were eligible. The primary
outcome measure was severe or massive bleeding defined according to the
Universal Definition of Perioperative Bleeding, stratified by P2Y12 inhibitor discontinuation. Secondary outcome measures included four additional definitions of major bleeding. Propensity score matching was performed to adjust for differences in preoperative and perioperative covariates.

Results

Of
2,311 patients who were included, 1,293 (55.9%) received clopidogrel
and 1,018 (44.1%) ticagrelor preoperatively. Mean time between
discontinuation and the operation was 4.5 ± 3.2 days for clopidogrel and
4.9 ± 3.0 days for ticagrelor. In the propensity score–matched cohort,
ticagrelor-treated patients had a higher incidence of major bleeding
according to Universal Definition of Perioperative Bleeding when
ticagrelor was discontinued 0 to 2 days compared with 3 days before the
operation (16.0% vs 2.7%, p = 0.003). Clopidogrel-treated
patients had a higher incidence of major bleeding according to the
Universal Definition of Perioperative Bleeding when clopidogrel was
discontinued 0 to 3 days compared with 4 to 5 days before the operation
(15.6% vs 8.3%, p = 0.031).

Conclusions

In
patients receiving ticagrelor 2 days before CABG and in those receiving
clopidogrel 3 days before CABG, there was an increased rate of severe
bleeding. Postponing nonemergent CABG for at least 3 days after
discontinuation of ticagrelor and 4 days after clopidogrel should be
considered.


Last updated on 2024-26-11 at 21:49