Key result
Ticagrelor shows no significant difference in major bleeding versus clopidogrel during CABG for ACS.
Why the study?
Coronary artery bypass grafting-related bleeding complications have not been compared between clopidogrel and ticagrelor-treated ACS patients outside clinical trials.
Observational (n=405)
Answers are grounded in this paper and cite their sources.
No excess CABG bleeding with ticagrelor versus clopidogrel in real-world ACS; leaves open whether observational findings should guide perioperative management.
OBJECTIVES: Ticagrelor reduces thrombotic events compared with clopidogrel in patients with acute coronary syndrome, but may also increase bleeding complications. Coronary artery bypass grafting (CABG)-related bleeding complications have not previously been compared in clopidogrel and ticagrelor-treated patients outside the controlled environment of clinical trials. METHODS: Four hundred and five consecutive CABG patients with acute coronary syndrome were included in a prospective observational study. The patients were treated with aspirin and ticagrelor (n = 173) or aspirin and clopidogrel (n = 232). Ticagrelor/clopidogrel was discontinued 5 days before surgery whenever deemed possible. Major bleeding complications according to modified blood conservation using antifibrinolytics in a randomized trial criteria (postoperative blood loss >1500 ml/12 h, re-exploration, red blood cell transfusion >10 units or death because of bleeding) were compared in all patients and when ticagrelor/clopidogrel was discontinued ≥5 days (n = 280), 2-4 days (n = 40) or 0-1 day before surgery (n = 85). RESULTS: Major bleeding complications did not differ significantly between ticagrelor- and clopidogrel-treated patients when all patients were compared (14.5 vs 13.8%, P = 0.89). Likewise, there were no significant differences between ticagrelor and clopidogrel when either drug was discontinued ≥5 days before surgery (6.8 vs 9.9%, P = 0.40) or 2-4 days before surgery (6.3 vs 25.0%, P = 0.21). When ticagrelor/clopidogrel was discontinued 0-1 day before surgery, there was a strong trend towards higher incidence of major bleeding in ticagrelor-treated patients (41.0 vs 21.7%, P = 0.063). CONCLUSIONS: There was no difference in major bleeding complications overall or when ticagrelor or clopidogrel was used in accordance with guidelines. In patients on dual antiplatelet medication up to 1 day before surgery, there tended to be more bleeding complications in ticagrelor-treated patients.
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Hansson et al. (2014) conducted an observational in Acute coronary syndrome undergoing coronary artery bypass grafting (CABG) (n=405). Ticagrelor vs. Clopidogrel was evaluated on Major bleeding complications (postoperative blood loss >1500 ml/12 h, re-exploration, red blood cell transfusion >10 units or death because of bleeding) (p=0.89). Ticagrelor showed no significant difference in overall major bleeding complications compared to clopidogrel in acute coronary syndrome patients undergoing CABG (14.5% vs 13.8%; P=0.89).
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