Key result
Discontinuing DAPT <3 days before off-pump CABG linked to ~145% greater postoperative bleeding risk.
Why the study?
The study was designed to assess the risk factors for adverse events following off-pump CABG in patients receiving DAPT.
Does discontinuing DAPT <3 days before off-pump CABG increase the risk of major bleeding and adverse events in patients on antiplatelet therapy?
Observational (n=2,012)
Does discontinuing DAPT <3 days before off-pump CABG increase the risk of major bleeding and adverse events in patients on antiplatelet therapy?
Discontinuing aspirin and clopidogrel less than 3 days before off-pump CABG significantly increases the risk of major bleeding complications, myocardial ischemia, and death.
Late DAPT discontinuation before off-pump CABG was associated with higher bleeding; leaves optimal timing open pending RCTs.
This retrospective study assessed the risk factors for adverse events following off-pump coronary artery bypass graft (CABG) surgery with dual antiplatelet therapy (DAPT). Records (between 2013 and 2017) were reviewed for patients who discontinued DAPT (clopidogrel 75 mg and aspirin 100 mg) ≤5 days before off-pump CABG. The primary outcome was the incidence of a Bleeding Academic Research Consortium (BARC) type 4 major event. Factors associated with bleeding events and perioperative myocardial ischemia were evaluated using multivariable logistic regression. The incidence of major bleeding events was 17.6% in 2012 patients. Adjusted multiple logistic regression analysis showed that the risk of postoperative bleeding increased when DAPT was discontinued <3 days before surgery (day 2: adjusted odds ratio [OR]: 1.70, 95% confidence interval [CI]: 1.09-2.64; day 1: adjusted OR: 2.37, 95% CI: 1.49-3.77; day 0: adjusted OR: 2.45, 95% CI: 1.53-3.92). The adjusted risk of mortality (OR: 13.14, 95% CI: 4.55-37.94) was increased with bleeding complications. In subgroup analysis, perioperative myocardial ischemia was related to increased blood loss (adjusted OR: 1.10, 95% CI: 1.02-1.18). Aspirin and clopidogrel should optimally be discontinued >3 days before CABG to reduce the risk of bleeding complications, myocardial ischemia, and death.
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Cheng et al. (2020) conducted an observational in Patients on antiplatelet therapy undergoing off-pump CABG (n=2,012). Discontinuation of DAPT <3 days before surgery vs. Discontinuation ≥3 days before surgery was evaluated on Incidence of a Bleeding Academic Research Consortium (BARC) type 4 major event (OR 2.45, 95% CI 1.53-3.92). Discontinuing DAPT <3 days before off-pump CABG significantly increased the risk of postoperative bleeding compared to earlier discontinuation (day 0 adjusted OR 2.45; 95% CI 1.53-3.92).
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