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Eur Heart J Qual Care Clin Outcomes. 2018 Oct 1;4(4):246-257. doi: 10.1093/ehjqcco/qcy027.

Variation in preoperative antithrombotic strategy, severe bleeding, and use of blood products in coronary artery bypass grafting: results from the multicentre E-CABG registry.

Author information

1
Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
2
Department of Surgery, University of Turku, Hämeentie 11, PO Box, Turku, Finland.
3
Department of Surgery, Oulu University Hospital and University of Oulu, Kajaanintie 50, Oulu, Finland.
4
Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield, Hospital, Groby Road, Leicester, Leicestershire, UK.
5
Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo, -Forlanini Hospital, Circonvallazione Gianicolense, 87, Rome, Italy.
6
Hamburg University Heart Center, Martinistraße 52, Hamburg, Germany.
7
Department of Cardiovascular Surgery, Division of Cardiovascular Surgery, Verona University Hospital, P. Le Stefani 1, Verona, Italy.
8
Department of Cardiovascular Surgery, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany and Città di Lecce Hospital GVM Care&Research, Strada Provinciale per Arnesano km 4, Lecce LE, Italy.
9
Department of Cardiovascular Surgery, Centro Clinico-Diagnostico "G.B. Morgagni", Centro Cuore, Via della Resistenza, 31, Pedara CT, Italy.
10
Department of Cardiovascular Surgery, St. Anna Hospital, Catanzaro, Viale Papa Pio X, 111, Catanzaro, Italy.
11
Division of Cardiac Surgery, University of Genoa, Largo Rosanna Benzi, 10, Genova GE, Italy.
12
Division of Cardiac Surgery, University of Parma, Via Gramsci 14 - Parma, Italy.
13
Department of Cardiac Surgery, Centro Cardiologico - Fondazione Monzino IRCCS, University of Milan, Via Carlo Parea, 4, Milan MI, Italy.
14
Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Rue du Général Koenig, Reims, France.
15
Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, 2 Rue Henri le Guilloux, Rennes, France.
16
Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, 3 Boulevard Alexandre Fleming, Besançon, France.
17
National Center of Global Health, Istituto Superiore di Sanità, Via Giano della Bella 34, Rome RM, Italy.
18
Department of Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, Naples, Italy.
19
Division of Cardiac Surgery, Ospedali Riuniti, via Farneto 3, Trieste, Italy.
20
Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Karolinska Universitetssjukhuset, Karolinska vägen, Solna, Sweden.

Abstract

Aims:

No data exists on inter-institutional differences in terms of adherence to international guidelines regarding the discontinuation of antithrombotics and rates of severe bleeding in coronary artery bypass grafting (CABG).

Methods and results:

This is an analysis of 7118 patients from the prospective multicentre European CABG (E-CABG) registry who underwent isolated CABG in 15 European centres. Preoperative pause of P2Y12 receptor antagonists shorter than that suggested by the 2017 ESC guidelines (overall 11.6%) ranged from 0.7% to 24.8% between centres (adjusted P < 0.0001) and increased the rate of severe-massive bleeding [E-CABG bleeding grades 2-3, OR 1.66, 95% confidence interval (CI) 1.27-2.17; Universal Definition of Perioperative Bleeding (UDPB) bleeding grades 3-4, OR 1.50, 95% CI 1.16-1.93]. The incidence of resternotomy for bleeding (overall 2.6%) ranged from 0% to 6.9% (adjusted P < 0.0001), and surgical site bleeding (overall 59.6%) ranged from 0% to 84.6% (adjusted P = 0.003). The rate of the UDPB bleeding grades 3-4 (overall 8.4%) ranged from 3.7% to 22.3% (P < 0.0001), and of the E-CABG bleeding grades 2-3 (overall 6.5%) ranged from 0.4% to 16.4% between centres (P < 0.0001). Resternotomy for bleeding (adjusted OR 5.04, 95% CI 2.85-8.92), UDPB bleeding grades 3-4 (adjusted OR 6.61, 95% CI 4.42-9.88), and E-CABG bleeding grades 2-3 (adjusted OR 8.71, 95% CI 5.76-13.15) were associated with an increased risk of hospital/30-day mortality.

Conclusions:

Adherence to the current guidelines on the early discontinuation of P2Y12 receptor antagonists is of utmost importance to reduce excessive bleeding and early mortality after CABG. Inter-institutional variation should be considered for a correct interpretation of the results in multicentre studies evaluating perioperative bleeding and use of blood products.

PMID:
29939246
DOI:
10.1093/ehjqcco/qcy027
[Indexed for MEDLINE]

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