Key result
Double antiplatelet therapy with aspirin and clopidogrel did not significantly increase major bleeding compared to aspirin alone (16% vs 12%, p=0.77), whereas low preoperative thrombin generation potential strongly predicted bleeding risk.
Why the study?
Does dual antiplatelet therapy (aspirin and clopidogrel) compared to aspirin alone increase major bleeding post-CABG in acute coronary syndrome patients?
Observational (n=100)
No
Does dual antiplatelet therapy (aspirin and clopidogrel) compared to aspirin alone increase major bleeding post-CABG in acute coronary syndrome patients?
Absolute Event Rate: 16% vs 12%
p-value: p=0.77
Pre-operative thrombin generation potential (EXTEM AUC), rather than the use of single versus dual antiplatelet therapy, correlates with major surgical bleeding post-CABG.
DAPT should not yet change post-CABG bleeding management in ACS; leaves open thrombin generation potential for risk stratification.
AIM: To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting (CABG). METHODS: Two groups of CABG patients were studied: Group A, treated with aspirin alone (n = 50), and Group B treated with aspirin and clopidogrel (n = 50). Both had similar preoperative, clinical, biologic characteristics and operative management. Classic coagulation parameters and rotational thromboelastometry (ROTEM) profiles were determined preoperatively for both groups and the same heparin treatment was administered. ROTEM profiles (INTEM and EXTEM assays) were analyzed, both for traditional parameters, and thrombin generation potential, expressed by area-under-curve (AUC). RESULTS: There was no significant difference between rates of major bleeding between patients treated with aspirin alone, compared with those treated with aspirin and clopidogrel (12% vs 16%, P = 0.77). In the 14 cases of major bleeding, pre-operative classic coagulation and traditional ROTEM parameters were comparable. Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders (5030 ± 1115 Ohm*min) than non-bleeders (6568 ± 548 Ohm*min) (P < 0.0001). CONCLUSION: We observed that patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC, regardless of antiplatelet treatment. This suggests that thrombin generation potential, irrespective of the degree of platelet inhibition, correlates with surgical bleeding.
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Tarzia et al. (2015) conducted an observational in Acute coronary syndrome (n=100). Aspirin and clopidogrel vs. Aspirin alone was evaluated on Major bleeding (p=0.77). Double antiplatelet therapy with aspirin and clopidogrel did not significantly increase major bleeding compared to aspirin alone (16% vs 12%, p=0.77), whereas low preoperative thrombin generation potential strongly predicted bleeding risk.
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