Key result
Preoperative antiplatelet continuation is linked to ~17% lower 30-day adverse events without more bleeding.
Why the study?
The clinical effects of preoperative antiplatelet therapy discontinuation timing on major bleeding and adverse cardiac events in patients undergoing CABG were unclear.
Does continuing preoperative antiplatelet therapy up to 7 days before surgery reduce composite adverse events without increasing major bleeding in patients with ACS undergoing CABG?
Cohort (n=41,689)
No
Does continuing preoperative antiplatelet therapy up to 7 days before surgery reduce composite adverse events without increasing major bleeding in patients with ACS undergoing CABG?
Continuing antiplatelet therapy within 7 days prior to CABG in patients with ACS safely reduces early ischemic events without exacerbating major surgical bleeding, supporting tailored discontinuation timelines over uniform early cessation.
Antiplatelet continuation ≤7 days pre-CABG was associated with fewer adverse events without more bleeding; supports individualized timing but leaves open need for RCTs.
Background: The aim of this study wasto evaluate the clinical effects of preoperative antiplatelet therapy (APT) discontinuation timing on major bleeding and adverse cardiac events in patients undergoing coronary artery bypass grafting (CABG). Methods: This retrospective cohort study analyzed data from Fuwai Cardiac Surgery Database (FCSD), specifically from 41,689 patients with acute coronary syndrome undergoing isolated CABG (2009-2019). A comparison was conducted between 10,739 patients treated with continuation APT (AP group; discontinued ≤7 days preoperation; including aspirin alone, clopidogrel alone, or aspirin + clopidogrel) and 30,950 patients with discontinuation therapy (NAP group; >7 days preoperation). Major bleeding events were defined according to the Bleeding Academic Research Consortium-CABG criteria. Composite adverse events (30-day all-cause mortality, stroke, myocardial infarction, and acute renal failure) were assessed. Multivariable logistic regression was applied to estimate effects. Results: Adverse cardiac events occurred in 7.8% of patients in the AP group and 9.1% in the NAP group (P<0.001), but there was no difference in the incidence of major bleeding events. Multivariable analysis showed that continuation therapy significantly decreased the risk of adverse cardiac events [odds ratio (OR) 0.832; 95% confidence interval (CI): 0.754-0.918; P<0.001] without increasing the risk of major bleeding events (OR 1.006; 95% CI: 0.926-1.093; P=0.88). Subgroup analysis identified certain strategies for reducing adverse events without bleeding. Conclusions: Preoperative continued APT significantly reduces the risk of 30-day adverse cardiac events post-CABG without increasing the risk of major bleeding. Optimal strategies include clopidogrel alone (discontinued <3 days preoperatively) and dual-antiplatelet therapy (aspirin + clopidogrel discontinued 5-7 days preoperatively).
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Liu et al. (2026) conducted a cohort in Acute coronary syndrome undergoing isolated CABG (n=41,689). Preoperative antiplatelet therapy continuation (≤7 days preoperation) vs. Antiplatelet therapy discontinuation (>7 days preoperation) was evaluated on Composite adverse events (30-day all-cause mortality, stroke, myocardial infarction, and acute renal failure) (OR 0.832, 95% CI 0.754-0.918, p=<0.001). Preoperative continuation of antiplatelet therapy (≤7 days before surgery) significantly reduced the risk of 30-day composite adverse cardiac events (OR 0.832) without increasing the risk of major bleeding.
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