Bleeding in Patients Treated With Ticagrelor or Clopidogrel Before Coronary Artery Bypass Grafting
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Bleeding in Patients Treated With Ticagrelor or Clopidogrel Before Coronary Artery Bypass Grafting. / 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; Dalén, Magnus.
In: ANN THORAC SURG, Vol. 107, No. 6, 06.2019, p. 1690-1698.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Bleeding in Patients Treated With Ticagrelor or Clopidogrel Before Coronary Artery Bypass Grafting
AU - Holm, Manne
AU - Biancari, Fausto
AU - Khodabandeh, Sorosh
AU - Gherli, Riccardo
AU - Airaksinen, Juhani
AU - Mariscalco, Giovanni
AU - Gatti, Giuseppe
AU - Reichart, Daniel
AU - Onorati, Francesco
AU - De Feo, Marisa
AU - Santarpino, Giuseppe
AU - Rubino, Antonino S
AU - Maselli, Daniele
AU - Santini, Francesco
AU - Nicolini, Francesco
AU - Zanobini, Marco
AU - Kinnunen, Eeva-Maija
AU - Ruggieri, Vito G
AU - Perrotti, Andrea
AU - Rosato, Stefano
AU - Dalén, Magnus
N1 - Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
PY - 2019/6
Y1 - 2019/6
N2 - 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.
AB - 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.
KW - Aged
KW - Clopidogrel/administration & dosage
KW - Coronary Artery Bypass
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Platelet Aggregation Inhibitors/administration & dosage
KW - Postoperative Hemorrhage/chemically induced
KW - Preoperative Period
KW - Prospective Studies
KW - Purinergic P2Y Receptor Antagonists/administration & dosage
KW - Ticagrelor/administration & dosage
U2 - 10.1016/j.athoracsur.2019.01.086
DO - 10.1016/j.athoracsur.2019.01.086
M3 - SCORING: Journal article
C2 - 30898561
VL - 107
SP - 1690
EP - 1698
JO - ANN THORAC SURG
JF - ANN THORAC SURG
SN - 0003-4975
IS - 6
ER -
