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Eur Heart J. 2016 Jan 7;37(2):189-97. doi: 10.1093/eurheartj/ehv381. Epub 2015 Sep 1.

Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study.

Author information

1
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
2
Department of Cardiothoracic Surgery, University Hospital, Uppsala, Sweden.
3
Department of Cardiothoracic Surgery, Blekinge Hospital, Karlskrona, Sweden.
4
Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden.
5
Department of Cardiothoracic Surgery, University Hospital and University Health Care Research Centre, Örebro, Sweden.
6
Department of Cardiothoracic Surgery, University Hospital, Umeå, Sweden.
7
Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
8
Department of Cardiothoracic Surgery, University Hospital, Linköping, Sweden.
9
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden anders.jeppsson@vgregion.se.

Abstract

AIMS:

Excessive bleeding impairs outcome after coronary artery bypass grafting (CABG). Current guidelines recommend withdrawal of clopidogrel and ticagrelor 5 days (120 h) before elective surgery. Shorter discontinuation would reduce the risk of thrombotic events and save hospital resources, but may increase the risk of bleeding. We investigated whether a shorter discontinuation time before surgery increased the incidence of CABG-related major bleeding complications and compared ticagrelor- and clopidogrel-treated patients.

METHODS AND RESULTS:

All acute coronary syndrome patients in Sweden on dual antiplatelet therapy with aspirin and ticagrelor (n = 1266) or clopidogrel (n = 978) who underwent CABG during 2012-13 were included in a retrospective observational study. The incidence of major bleeding complications according to the Bleeding Academic Research Consortium-CABG definition was 38 and 31%, respectively, when ticagrelor/clopidogrel was discontinued <24 h before surgery. Within the ticagrelor group, there was no significant difference between discontinuation 72-120 or >120 h before surgery [odds ratio (OR) 0.93 (95% confidence interval, CI, 0.53-1.64), P = 0.80]. In contrast, clopidogrel-treated patients had a higher incidence when discontinued 72-120 vs. >120 h before surgery (OR 1.71 (95% CI 1.04-2.79), P = 0.033). The overall incidence of major bleeding complications was lower with ticagrelor [12.9 vs. 17.6%, adjusted OR 0.72 (95% CI 0.56-0.92), P = 0.012].

CONCLUSION:

The incidence of CABG-related major bleeding was high when ticagrelor/clopidogrel was discontinued <24 h before surgery. Discontinuation 3 days before surgery, as opposed to 5 days, did not increase the incidence of major bleeding complications with ticagrelor, but increased the risk with clopidogrel. The overall risk of major CABG-related bleeding complications was lower with ticagrelor than with clopidogrel.

KEYWORDS:

Acute coronary syndrome; Bleeding complications; Cardiac surgery; Dual antiplatelet therapy

PMID:
26330426
PMCID:
PMC4703906
DOI:
10.1093/eurheartj/ehv381
[Indexed for MEDLINE]
Free PMC Article

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