Key result
Discontinuation of dual antiplatelet therapy within 24 hours before coronary artery bypass grafting significantly increased the risk of surgical re-exploration for bleeding (HR 6.9) compared to earlier discontinuation.
Why the study?
In patients with acute coronary syndromes who urgently need coronary artery surgery, dual antiplatelet therapy can increase the risk of severe perioperative bleeding complications.
Does dual antiplatelet therapy discontinuation < 24 hours prior to CABG increase bleeding complications in patients undergoing coronary artery bypass grafting?
Cohort (n=333)
No
Does dual antiplatelet therapy discontinuation < 24 hours prior to CABG increase bleeding complications in patients undergoing coronary artery bypass grafting?
Hazard Ratio: 6.9 (95% CI 1.01–47.5)
p-value: p=0.048
Discontinuation of dual antiplatelet therapy less than 24 hours before CABG significantly increases the risk of major bleeding and surgical re-exploration, particularly in patients taking ticagrelor.
DAPT effects on bleeding risk in urgent CABG patients remain uncertain; leaves open optimal strategy pending higher-level evidence.
INTRODUCTION: Dual antiplatelet therapy reduces the risk of cardiovascular death, myocardial infarction and recurrence of adverse ischemic events in patients affected by acute coronary syndromes, but in patients urgently needing coronary artery surgery it can increase the risk of severe perioperative bleeding complications. AIM: We evaluated the impact of dual antiplatelet therapy (DAPT) based on acetylsalicylic acid plus clopidogrel or ticagrelor in patients undergoing coronary artery bypass grafting (CABG). MATERIAL AND METHODS: = 24) prior to CABG. RESULTS: = 0.002). CONCLUSIONS: Dual antiplatelet therapy ongoing until 1 day or 24 hours before CABG showed a significantly increased risk of bleeding complications in comparison with its discontinuation at 2-3 and > 3-4 days before, respectively. Major blood loss and surgical re-exploration were not associated with increased risk of operative all-cause or bleeding-related mortality. As expected, taking ticagrelor compared with clopidogrel in the short interval confers a higher risk of bleeding complications.
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Nardi et al. (2021) conducted a cohort in Coronary artery disease requiring CABG (n=333). Dual antiplatelet therapy discontinuation < 24 hours before CABG vs. Discontinuation > 48 hours before CABG was evaluated on Surgical mediastinal re-exploration for bleeding (HR 6.9, 95% CI 1.01-47.5, p=0.048). Discontinuation of dual antiplatelet therapy within 24 hours before coronary artery bypass grafting significantly increased the risk of surgical re-exploration for bleeding (HR 6.9) compared to earlier discontinuation.
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