Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy

Author:

Deppe Antje Christin1,Schlachtenberger Georg1ORCID,Gerfer Stephen1,Choi Yeong-Hoon2,Zeriouh Mohamed2,Liakopoulos Oliver1,Wahlers Thorsten C.W.1

Affiliation:

1. Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany

2. Department of Cardiac Surgery, Kerckhoff Vascular Centre Bad Nauheim, Bad Nauheim, Hessen, Germany

Abstract

Abstract Objective Patients with acute coronary syndrome are treated with dual antiplatelet therapy containing acetylsalicylic acid (ASA) and P2Y12 antagonists. In case of urgent coronary artery bypass grafting this might be associated with increasing risks of bleeding complications. Methods Data from 1200 consecutive urgent operations between 2010 and 2018 were obtained from our institutional patient database. For this study off-pump surgery was excluded. The primary composite end point major bleeding consisted of at least one end point: transfusion ≥ 5 packed red blood cells within 24 hours, rethoracotomy due to bleeding, chest tube output >2000 mL within 24 hours. Demographic data, peri-, and postoperative variables and outcomes were compared between patients treated with mono antiplatelet therapy, ASA + clopidogrel (ASA-C) +ticagrelor (ASA-T) or +prasugrel (ASA-P) < 72 hours before surgery. Furthermore, we compared patients with dual antiplatelet therapy with ASA monotherapy. Results From 1,086 patients, 475 (44%) received dual antiplatelet therapy. Three-hundred seventy-two received ASA-C (77.7%), 72 ASA-T (15%), and 31 ASA-P (6.5%). Major bleeding (44 vs. 23%, p < 0.0001) was more frequently in patients receiving dual therapy with higher rates of massive drainage loss within 24 hours (23 vs. 11%, p < 0.0001) of mass transfusion (34 vs. 16%, p < 0.0001) and rethoracotomy (10 vs. 5%, p = 0.002) when compared with ASA. In this analysis, ASA-T and ASA-P were not associated with higher bleeding complications compared with ASA-C. Conclusion Dual antiplatelet therapy is associated with higher rates of major bleeding. Further studies should examine the difference in the prevalence of major bleeding complications in the different dual antiplatelet therapy regimes in patients requiring urgent surgery.

Publisher

Georg Thieme Verlag KG

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,Surgery

Reference29 articles.

1. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology;B JS Ibanez;Eur Heart J,2018

2. Ticagrelor versus clopidogrel in patients with acute coronary syndromes;L Wallentin;N Engl J Med,2009

3. Prasugrel versus clopidogrel in patients with acute coronary syndromes;S D Wiviott;N Engl J Med,2007

4. Coronary artery bypass grafting-related bleeding complications in real-life acute coronary syndrome patients treated with clopidogrel or ticagrelor;E C Hansson;Eur J Cardiothorac Surg,2014

5. The 2017 EACTS guidelines on perioperative medication in adult cardiac surgery and patient blood management;M Sousa-Uva;Eur J Cardiothorac Surg,2018

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