Safety of Preoperative Use of Ticagrelor With or Without Aspirin Compared With Aspirin Alone in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting
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Safety of Preoperative Use of Ticagrelor With or Without Aspirin Compared With Aspirin Alone in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting. / Gherli, Riccardo; Mariscalco, Giovanni; Dalén, Magnus; Onorati, Francesco; Perrotti, Andrea; Chocron, Sidney; Verhoye, Jean Philippe; Gulbins, Helmut; Reichart, Daniel; Svenarud, Peter; Faggian, Giuseppe; Santarpino, Giuseppe; Fischlein, Theodor; Maselli, Daniele; Dominici, Carmelo; Musumeci, Francesco; Rubino, Antonino S; Mignosa, Carmelo; De Feo, Marisa; Bancone, Ciro; Gatti, Giuseppe; Maschietto, Luca; Santini, Francesco; Nicolini, Francesco; Gherli, Tiziano; Zanobini, Marco; Kinnunen, Eeva-Maija; Ruggieri, Vito G; Rosato, Stefano; Biancari, Fausto.
in: JAMA CARDIOL, Jahrgang 1, Nr. 8, 01.11.2016, S. 921-928.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Safety of Preoperative Use of Ticagrelor With or Without Aspirin Compared With Aspirin Alone in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting
AU - Gherli, Riccardo
AU - Mariscalco, Giovanni
AU - Dalén, Magnus
AU - Onorati, Francesco
AU - Perrotti, Andrea
AU - Chocron, Sidney
AU - Verhoye, Jean Philippe
AU - Gulbins, Helmut
AU - Reichart, Daniel
AU - Svenarud, Peter
AU - Faggian, Giuseppe
AU - Santarpino, Giuseppe
AU - Fischlein, Theodor
AU - Maselli, Daniele
AU - Dominici, Carmelo
AU - Musumeci, Francesco
AU - Rubino, Antonino S
AU - Mignosa, Carmelo
AU - De Feo, Marisa
AU - Bancone, Ciro
AU - Gatti, Giuseppe
AU - Maschietto, Luca
AU - Santini, Francesco
AU - Nicolini, Francesco
AU - Gherli, Tiziano
AU - Zanobini, Marco
AU - Kinnunen, Eeva-Maija
AU - Ruggieri, Vito G
AU - Rosato, Stefano
AU - Biancari, Fausto
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Importance: The optimal timing of discontinuation of ticagrelor before cardiac surgery is controversial.Objective: To evaluate the safety of preoperative use of ticagrelor with or without aspirin in patients with acute coronary syndromes (ACS) undergoing isolated coronary artery bypass grafting (CABG) compared with aspirin alone.Design, Setting, and Participants: This prospective, multicenter clinical trial was performed at 15 European centers of cardiac surgery. Participants were patients with ACS undergoing isolated CABG from the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry between January and September 2015.Exposures: Before surgery, patients received ticagrelor with or without aspirin or aspirin alone.Main Outcomes and Measures: Severe bleeding as defined by the Universal Definition of Perioperative Bleeding (UDPB) and E-CABG bleeding classification criteria. A propensity score-matched analysis was performed to adjust for differences in baseline and operative covariates.Results: Of 2482 patients from the E-CABG registry, the study cohort included 786 (31.7%) consecutive patients with ACS (mean [SD] age, 67.1 [9.3] years; range, 32-88 years), and 132 (16.8%) were female. One-to-one propensity score matching provided 215 pairs, whose baseline and operative covariates had a standardized difference of less than 10%. Preoperative use of ticagrelor was associated with a similar risk of bleeding according to the UDPB and E-CABG bleeding classifications, but the incidence of platelet transfusion was higher in the ticagrelor group (13.5% [29 of 215] vs 6.0% [13 of 215]). Compared with those receiving aspirin alone, continuing ticagrelor up to the time of surgery or discontinuing its use less than 2 days before surgery was associated with a higher risk of platelet transfusion (22.7% [5 of 22] vs 6.4% [12 of 187]) and E-CABG bleeding grades 2 and 3 (18.2% [4 of 22] vs 5.9% [11 of 187]) and tended to have an increased risk of UDPB grades 3 and 4 (22.7% [5 of 22] vs 9.6% [18 of 187]). Among patients in whom antiplatelet drug use was discontinued at least 2 days before surgery, the incidence of platelet transfusion was 12.4% (24 of 193) in the ticagrelor group and 3.6% (1 of 28) in the aspirin-alone group.Conclusions and Relevance: In propensity score-matched analyses among patients with ACS undergoing CABG, the use of preoperative ticagrelor with or without aspirin compared with aspirin alone was associated with more platelet transfusion but similar degree of bleeding; in patients receiving ticagrelor 1 day before or up until surgery, there was an increased rate of severe bleeding.
AB - Importance: The optimal timing of discontinuation of ticagrelor before cardiac surgery is controversial.Objective: To evaluate the safety of preoperative use of ticagrelor with or without aspirin in patients with acute coronary syndromes (ACS) undergoing isolated coronary artery bypass grafting (CABG) compared with aspirin alone.Design, Setting, and Participants: This prospective, multicenter clinical trial was performed at 15 European centers of cardiac surgery. Participants were patients with ACS undergoing isolated CABG from the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry between January and September 2015.Exposures: Before surgery, patients received ticagrelor with or without aspirin or aspirin alone.Main Outcomes and Measures: Severe bleeding as defined by the Universal Definition of Perioperative Bleeding (UDPB) and E-CABG bleeding classification criteria. A propensity score-matched analysis was performed to adjust for differences in baseline and operative covariates.Results: Of 2482 patients from the E-CABG registry, the study cohort included 786 (31.7%) consecutive patients with ACS (mean [SD] age, 67.1 [9.3] years; range, 32-88 years), and 132 (16.8%) were female. One-to-one propensity score matching provided 215 pairs, whose baseline and operative covariates had a standardized difference of less than 10%. Preoperative use of ticagrelor was associated with a similar risk of bleeding according to the UDPB and E-CABG bleeding classifications, but the incidence of platelet transfusion was higher in the ticagrelor group (13.5% [29 of 215] vs 6.0% [13 of 215]). Compared with those receiving aspirin alone, continuing ticagrelor up to the time of surgery or discontinuing its use less than 2 days before surgery was associated with a higher risk of platelet transfusion (22.7% [5 of 22] vs 6.4% [12 of 187]) and E-CABG bleeding grades 2 and 3 (18.2% [4 of 22] vs 5.9% [11 of 187]) and tended to have an increased risk of UDPB grades 3 and 4 (22.7% [5 of 22] vs 9.6% [18 of 187]). Among patients in whom antiplatelet drug use was discontinued at least 2 days before surgery, the incidence of platelet transfusion was 12.4% (24 of 193) in the ticagrelor group and 3.6% (1 of 28) in the aspirin-alone group.Conclusions and Relevance: In propensity score-matched analyses among patients with ACS undergoing CABG, the use of preoperative ticagrelor with or without aspirin compared with aspirin alone was associated with more platelet transfusion but similar degree of bleeding; in patients receiving ticagrelor 1 day before or up until surgery, there was an increased rate of severe bleeding.
KW - Acute Coronary Syndrome/drug therapy
KW - Adenosine/adverse effects
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Aspirin/therapeutic use
KW - Coronary Artery Bypass
KW - Female
KW - Humans
KW - Middle Aged
KW - Platelet Aggregation Inhibitors/therapeutic use
KW - Postoperative Hemorrhage
KW - Prospective Studies
KW - Ticagrelor
U2 - 10.1001/jamacardio.2016.3028
DO - 10.1001/jamacardio.2016.3028
M3 - SCORING: Journal article
C2 - 27653165
VL - 1
SP - 921
EP - 928
JO - JAMA CARDIOL
JF - JAMA CARDIOL
SN - 2380-6583
IS - 8
ER -