MiR-223 levels predicting perioperative bleeding in off-pump coronary artery bypass grafting

BACKGROUND: To investigate the predictive value of platelet-related microRNAs (miRNAs) for bleeding during and after off-pump coronary artery bypass grafting (OPCABG) and the influence of dual antiplatelet therapy (DAPT) on miRNAs. METHODS: This prospective study included 59 patients scheduled for OPCABG. The plasma miR-126 and miR-223 levels were measured and platelet aggregation was determined by thromboelastography during DAPT. The plasma miRNA levels were compared between patients treated with ticagrelor or clopidogrel. Multivariable logistic regression analysis was performed to determine the independent risk factors for bleeding during and after surgery. Active bleeding was defined as a blood loss >1.5 mL/kg/h for 6 consecutive hours within the first 24 hours or in case of reoperation during the first 12 postoperative hours. Severe perioperative bleeding was defined using the universal definition of perioperative bleeding in adult cardiac surgery. RESULTS: Higher circulating miR-223 levels [odds ratio (OR) =1.348, 95% confidence interval (CI): 1.001–1.814, P=0.047] and lower body mass index (OR =0.648, 95% CI: 0.428–0.980, P=0.040) were independent predictors for severe perioperative bleeding in OPCABG. Ticagrelor treatment led to significant increases in circulating miR-223 levels compared with clopidogrel treatment. CONCLUSIONS: The plasma miR-223 levels served as a predictor for bleeding during and after OPCABG. Circulating miR-223 levels were significantly elevated with ticagrelor treatment compared with clopidogrel treatment. MiR-223 may be a novel biomarker for bleeding in cardiac surgery and can help explain the different efficacies of ticagrelor and clopidogrel.