eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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3/2021
vol. 18
 
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abstract:
Original paper

The impact of dual antiplatelet therapy administration on the risk of bleeding complications during coronary artery bypass surgery

Paolo Nardi
1
,
Calogera Pisano
1
,
Maria Turturici
1
,
Fabio Bertoldo
1
,
Vito Renato Maggio
1
,
Carlo Bassano
1
,
Dario Buioni
1
,
Antonio Scafuri
1
,
Claudia Altieri
1
,
Giovanni Ruvolo
1

  1. Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
Kardiochirurgia i Torakochirurgia Polska 2021; 18 (3): 145-151
DOI: https://doi.org/10.5114/kitp.2021.109407
Online publish date: 2021/10/05
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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
Three hundred and thirty-three patients underwent coronary artery bypass grafting with DAPT discontinuation > 72 hours or 3–4 days (group A, n = 159), 48–72 hours or 2–3 days (group B, n = 126), < 24 hours or 0–1 day (group C, n = 24) prior to CABG.

Results
Operative mortality was 1.87% (group A), 0.79% (group B), absent (group C). The incidence of mediastinal re-exploration was 1.25% or 2 patients (group A), 1.59% or 2 patients (group B), 8.33% or 4 patients (group C) (p = 0.01). Group C showed postoperatively a greater incidence of a blood loss greater than 500 ml at 6 hours and a blood loss from chest tube drainages significantly higher at 6 and 24 hours (p < 0.01). Multivariate analysis showed that ongoing ticagrelor intake in group C (HR = 42.4; p = 0.02) and group C (HR = 6.9; p = 0.04) were the only independent predictors of surgical re-exploration. In group C, surgical re-exploration was 2.56% or 1/39 patients taking clopidogrel, 33.3% or 3/9 patients taking ticagrelor (p = 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.

keywords:

dual antiplatelet therapy, coronary artery bypass grafting, P2Y12 inhibitors
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