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

被引:36
|
作者
Holm, Manne
Biancari, Fausto
Khodabandeh, Sorosh
Gherli, Riccardo
Airaksinen, Juhani
Mariscalco, Giovanni
Gatti, Giuseppe
Reichart, Daniel
Onorati, Francesco
De Feo, Marisa
Santarpino, Giuseppe
Rubino, Antonino S.
Maselli, Daniele
Santini, Francesco
Nicolini, Francesco
Zanobini, Marco
Kinnunen, Eeva-Maija
Ruggieri, Vito G.
Perrotti, Andrea
Rosato, Stefano
Dalen, Magnus [1 ]
机构
[1] Karolinska Univ Hosp, Dept Cardiac Surg, Eugeniavagen 23,C12-28, SE-17176 Stockholm, Sweden
来源
ANNALS OF THORACIC SURGERY | 2019年 / 107卷 / 06期
关键词
DUAL ANTIPLATELET THERAPY; UNIVERSAL DEFINITION; EUROPEAN MULTICENTER; PLATELET INHIBITION; CARDIAC-SURGERY; OUTCOMES; CLASSIFICATION; COMPLICATIONS;
D O I
10.1016/j.athoracsur.2019.01.086
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. We evaluated perioperative bleeding after coronary artery bypass grafting (CABG) in patients preoperatively treated with ticagrelor or clopidogrel, stratified by discontinuation of these P2Y(12) 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 P2Y(12) 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. (C) 2019 by The Society of Thoracic Surgeons
引用
收藏
页码:1690 / 1698
页数:9
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