eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
Current issue Archive Manuscripts accepted About the journal Supplements Editorial board Reviewers Abstracting and indexing Contact Instructions for authors Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
4/2019
vol. 16
 
Share:
Share:
abstract:
Original paper

Coronary artery bypass grafting on clopidogrel or ticagrelor therapy: interval of discontinuation and risk of bleeding

Paolo Nardi
1
,
Dionisio F. Colella
2
,
Calogera Pisano
1
,
Carlo Bassano
1
,
Antonio Scafuri
1
,
Fabio Bertoldo
1
,
Dario Buioni
1
,
Giovanni Ruvolo
1

1.
Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
2.
Anesthesiology Division, Tor Vergata University Hospital, Rome, Italy
Kardiochir Torakochir Pol 2019; 16 (4): 166-172
Online publish date: 2020/01/15
View full text Get citation
 
PlumX metrics:
Aim
To evaluate retrospectively the impact of ticagrelor or clopidogrel in patients taking dual antiplatelet aggregation therapy (DAPT, ASA + clopidogrel or ticagrelor) undergoing coronary artery bypass grafting (CABG) on postoperative bleeding complications and need for mediastinal surgical re-exploration, focusing on the interval of discontinuation of DAPT.

Material and methods
From January 2017 to January 2018, 190 patients underwent coronary artery bypass grafting with DAPT discontinuation 5 days (group 1, n = 82), 2–4 days (group 2, n = 84), or 0–1 days (group 3, n = 24) prior to CABG.

Results
As compared to group 1, blood loss from chest tube drainages at 24 hours was significantly higher in groups 2 and 3 (480 ±238 vs. 512 ±209 vs. 640 ±253 ml; p = 0.007 and p = 0.016). Incidence of surgical re-exploration for bleeding was 1.2% in group 1, 2.4% in group 2, 12.5% in group 3 (p = 0.014). Independent predictors of surgical re-exploration were group 3 (p = 0.05; HR = 9.2) and preoperative increased value of creatinine serum level (p = 0.02; HR = 1.3). In group 3, the incidence of re-exploration was 5.6% (1/18) in patients taking ASA + clopidogrel, 33.3% (2/6) in those taking ASA + ticagrelor (HR-32), respectively (p < 0.001). Operative mortality was 1.2% in group 1, 1.2% in group 2, absent in group 3 (p = not significant).

Conclusions
Continued DAPT intake until CABG shows a clear trend towards more bleeding complications when compared with its discontinuation. Major blood loss and surgical re-exploration were not associated with an increased risk of operative mortality. Ticagrelor intake confers a higher risk of bleeding in comparison with clopidogrel; by stopping its intake at least 2 days prior to surgery, an increased risk of bleeding complications is not observed.

keywords:

clopidogrel, ticagrelor, coronary artery bypass, bleeding

Quick links
© 2024 Termedia Sp. z o.o.
Developed by Bentus.