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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

Standard

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, Vol. 1, No. 8, 01.11.2016, p. 921-928.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Gherli, R, Mariscalco, G, Dalén, M, Onorati, F, Perrotti, A, Chocron, S, Verhoye, JP, Gulbins, H, Reichart, D, Svenarud, P, Faggian, G, Santarpino, G, Fischlein, T, Maselli, D, Dominici, C, Musumeci, F, Rubino, AS, Mignosa, C, De Feo, M, Bancone, C, Gatti, G, Maschietto, L, Santini, F, Nicolini, F, Gherli, T, Zanobini, M, Kinnunen, E-M, Ruggieri, VG, Rosato, S & Biancari, F 2016, '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', JAMA CARDIOL, vol. 1, no. 8, pp. 921-928. https://doi.org/10.1001/jamacardio.2016.3028

APA

Gherli, R., Mariscalco, G., Dalén, M., Onorati, F., Perrotti, A., Chocron, S., Verhoye, J. P., Gulbins, H., Reichart, D., Svenarud, P., Faggian, G., Santarpino, G., Fischlein, T., Maselli, D., Dominici, C., Musumeci, F., Rubino, A. S., Mignosa, C., De Feo, M., ... Biancari, F. (2016). 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. JAMA CARDIOL, 1(8), 921-928. https://doi.org/10.1001/jamacardio.2016.3028

Vancouver

Gherli R, Mariscalco G, Dalén M, Onorati F, Perrotti A, Chocron S et al. 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. JAMA CARDIOL. 2016 Nov 1;1(8):921-928. https://doi.org/10.1001/jamacardio.2016.3028

Bibtex

@article{5f7752a679b8450ca8d4e2278469df86,
title = "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",
abstract = "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.",
keywords = "Acute Coronary Syndrome/drug therapy, Adenosine/adverse effects, Adult, Aged, Aged, 80 and over, Aspirin/therapeutic use, Coronary Artery Bypass, Female, Humans, Middle Aged, Platelet Aggregation Inhibitors/therapeutic use, Postoperative Hemorrhage, Prospective Studies, Ticagrelor",
author = "Riccardo Gherli and Giovanni Mariscalco and Magnus Dal{\'e}n and Francesco Onorati and Andrea Perrotti and Sidney Chocron and Verhoye, {Jean Philippe} and Helmut Gulbins and Daniel Reichart and Peter Svenarud and Giuseppe Faggian and Giuseppe Santarpino and Theodor Fischlein and Daniele Maselli and Carmelo Dominici and Francesco Musumeci and Rubino, {Antonino S} and Carmelo Mignosa and {De Feo}, Marisa and Ciro Bancone and Giuseppe Gatti and Luca Maschietto and Francesco Santini and Francesco Nicolini and Tiziano Gherli and Marco Zanobini and Eeva-Maija Kinnunen and Ruggieri, {Vito G} and Stefano Rosato and Fausto Biancari",
year = "2016",
month = nov,
day = "1",
doi = "10.1001/jamacardio.2016.3028",
language = "English",
volume = "1",
pages = "921--928",
journal = "JAMA CARDIOL",
issn = "2380-6583",
publisher = "American Medical Association",
number = "8",

}

RIS

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 -