Why the study?
Some postoperative complications of CABG are closely linked with preoperative antiplatelet therapy, prompting an assessment of early clinical outcomes across patients with preserved versus impaired platelet function.
Does preoperative platelet dysfunction due to residual antiplatelet therapy increase postoperative bleeding and transfusion demands in patients undergoing isolated CABG?
Does preoperative platelet dysfunction due to residual antiplatelet therapy increase postoperative bleeding and transfusion demands in patients undergoing isolated CABG?
Residual effects of dual antiplatelet therapy or pronounced aspirin effects significantly increase the risk of postoperative bleeding and transfusion requirements in patients undergoing isolated CABG.
Residual DAPT or pronounced ASA effect was associated with higher bleeding and transfusion needs after CABG; leaves open optimal preoperative APT timing.
Background/Aim. Coronary artery bypass grafting (CABG) is the treatment of choice for a significant number of patients with ischemic heart disease. Some of the postoperative complications are closely linked with the preoperative antiplatelet therapy (APT). The aim of this study was to compare the early clinical outcomes of CABG in patients with preserved platelet (PLT) function and patients with PLT function impaired by the residual therapeutic effect of APT. Methods. A total of 181 patients with isolated CABG were enrolled in this prospective, nonrandomized, observational study. Patients were divided into four groups: control group (arachidonic acid-dependent PLT aggregation group), with aspirin-induced platelet inhibition (ASPI) test ? 790 aggregation units (AU)/min; mild (M) acetylsalicylic acid (ASA) effect (MASAE) group, with ASPI test = 410?789 AU/min; pronounced (P) ASA effect (PASAE) group, with ASPI test ? 409 AU/min; dual (D) APT (DAPT) group, with ASPI test ? 789 AU/min and adenosine diphosphate (ADP) test ? 405 AU/min. Preoperative data, intraoperative characteristics, and postoperative outcomes were obtained and com-pared between the groups. Results. A significant difference was found regarding the average time of APT cessation be-tween groups (p < 0.001). The DAPT group had a significantly higher frequency of drainage compared to the control (p = 0.004), MASAE (p = 0.001), and PASAE (p = 0.006) groups. The PASAE group had a significantly higher rate of chest reexploration compared to the MASAE group (p = 0.032). The DAPT group required significantly more packed red blood cells (PRBC) compared to the control (p < 0.001) and MASAE (p = 0.009) groups. The PASAE group received significantly more PRBC compared to the control (p < 0.001) and MASAE (p = 0.019) groups. The DAPT group required higher amounts of PLTs compared to the control (p < 0.001), MASAE (p = 0.002), and PASAE (p < 0.001) groups. The DAPT group received higher amounts of cryoprecipitate compared to the control (p = 0.002), MASAE (p = 0.009), and PASAE (p = 0.016) groups. Conclusion. Patients with a residual effect of DAPT, as well as patients with a pronounced residual effect of ASA, have a higher risk of postoperative bleeding and chest reexploration, as well as increased transfusion demands.
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Stojiljković et al. (2023) studied this question.
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