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Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study

AIMS: Excessive bleeding impairs outcome after coronary artery bypass grafting (CABG). Current guidelines recommend withdrawal of clopidogrel and ticagrelor 5 days (120 h) before elective surgery. Shorter discontinuation would reduce the risk of thrombotic events and save hospital resources, but may...

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Autores principales: Hansson, Emma C., Jidéus, Lena, Åberg, Bengt, Bjursten, Henrik, Dreifaldt, Mats, Holmgren, Anders, Ivert, Torbjörn, Nozohoor, Shahab, Barbu, Mikael, Svedjeholm, Rolf, Jeppsson, Anders
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4703906/
https://www.ncbi.nlm.nih.gov/pubmed/26330426
http://dx.doi.org/10.1093/eurheartj/ehv381
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author Hansson, Emma C.
Jidéus, Lena
Åberg, Bengt
Bjursten, Henrik
Dreifaldt, Mats
Holmgren, Anders
Ivert, Torbjörn
Nozohoor, Shahab
Barbu, Mikael
Svedjeholm, Rolf
Jeppsson, Anders
author_facet Hansson, Emma C.
Jidéus, Lena
Åberg, Bengt
Bjursten, Henrik
Dreifaldt, Mats
Holmgren, Anders
Ivert, Torbjörn
Nozohoor, Shahab
Barbu, Mikael
Svedjeholm, Rolf
Jeppsson, Anders
author_sort Hansson, Emma C.
collection PubMed
description AIMS: Excessive bleeding impairs outcome after coronary artery bypass grafting (CABG). Current guidelines recommend withdrawal of clopidogrel and ticagrelor 5 days (120 h) before elective surgery. Shorter discontinuation would reduce the risk of thrombotic events and save hospital resources, but may increase the risk of bleeding. We investigated whether a shorter discontinuation time before surgery increased the incidence of CABG-related major bleeding complications and compared ticagrelor- and clopidogrel-treated patients. METHODS AND RESULTS: All acute coronary syndrome patients in Sweden on dual antiplatelet therapy with aspirin and ticagrelor (n = 1266) or clopidogrel (n = 978) who underwent CABG during 2012–13 were included in a retrospective observational study. The incidence of major bleeding complications according to the Bleeding Academic Research Consortium-CABG definition was 38 and 31%, respectively, when ticagrelor/clopidogrel was discontinued <24 h before surgery. Within the ticagrelor group, there was no significant difference between discontinuation 72–120 or >120 h before surgery [odds ratio (OR) 0.93 (95% confidence interval, CI, 0.53–1.64), P = 0.80]. In contrast, clopidogrel-treated patients had a higher incidence when discontinued 72–120 vs. >120 h before surgery (OR 1.71 (95% CI 1.04–2.79), P = 0.033). The overall incidence of major bleeding complications was lower with ticagrelor [12.9 vs. 17.6%, adjusted OR 0.72 (95% CI 0.56–0.92), P = 0.012]. CONCLUSION: The incidence of CABG-related major bleeding was high when ticagrelor/clopidogrel was discontinued <24 h before surgery. Discontinuation 3 days before surgery, as opposed to 5 days, did not increase the incidence of major bleeding complications with ticagrelor, but increased the risk with clopidogrel. The overall risk of major CABG-related bleeding complications was lower with ticagrelor than with clopidogrel.
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spelling pubmed-47039062016-01-08 Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study Hansson, Emma C. Jidéus, Lena Åberg, Bengt Bjursten, Henrik Dreifaldt, Mats Holmgren, Anders Ivert, Torbjörn Nozohoor, Shahab Barbu, Mikael Svedjeholm, Rolf Jeppsson, Anders Eur Heart J FASTTRACK CLINICAL RESEARCH AIMS: Excessive bleeding impairs outcome after coronary artery bypass grafting (CABG). Current guidelines recommend withdrawal of clopidogrel and ticagrelor 5 days (120 h) before elective surgery. Shorter discontinuation would reduce the risk of thrombotic events and save hospital resources, but may increase the risk of bleeding. We investigated whether a shorter discontinuation time before surgery increased the incidence of CABG-related major bleeding complications and compared ticagrelor- and clopidogrel-treated patients. METHODS AND RESULTS: All acute coronary syndrome patients in Sweden on dual antiplatelet therapy with aspirin and ticagrelor (n = 1266) or clopidogrel (n = 978) who underwent CABG during 2012–13 were included in a retrospective observational study. The incidence of major bleeding complications according to the Bleeding Academic Research Consortium-CABG definition was 38 and 31%, respectively, when ticagrelor/clopidogrel was discontinued <24 h before surgery. Within the ticagrelor group, there was no significant difference between discontinuation 72–120 or >120 h before surgery [odds ratio (OR) 0.93 (95% confidence interval, CI, 0.53–1.64), P = 0.80]. In contrast, clopidogrel-treated patients had a higher incidence when discontinued 72–120 vs. >120 h before surgery (OR 1.71 (95% CI 1.04–2.79), P = 0.033). The overall incidence of major bleeding complications was lower with ticagrelor [12.9 vs. 17.6%, adjusted OR 0.72 (95% CI 0.56–0.92), P = 0.012]. CONCLUSION: The incidence of CABG-related major bleeding was high when ticagrelor/clopidogrel was discontinued <24 h before surgery. Discontinuation 3 days before surgery, as opposed to 5 days, did not increase the incidence of major bleeding complications with ticagrelor, but increased the risk with clopidogrel. The overall risk of major CABG-related bleeding complications was lower with ticagrelor than with clopidogrel. Oxford University Press 2016-01-07 2015-09-01 /pmc/articles/PMC4703906/ /pubmed/26330426 http://dx.doi.org/10.1093/eurheartj/ehv381 Text en © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle FASTTRACK CLINICAL RESEARCH
Hansson, Emma C.
Jidéus, Lena
Åberg, Bengt
Bjursten, Henrik
Dreifaldt, Mats
Holmgren, Anders
Ivert, Torbjörn
Nozohoor, Shahab
Barbu, Mikael
Svedjeholm, Rolf
Jeppsson, Anders
Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study
title Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study
title_full Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study
title_fullStr Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study
title_full_unstemmed Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study
title_short Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study
title_sort coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study
topic FASTTRACK CLINICAL RESEARCH
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4703906/
https://www.ncbi.nlm.nih.gov/pubmed/26330426
http://dx.doi.org/10.1093/eurheartj/ehv381
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