Aim: To evaluate retrospectively the impact of ticagrelor or clopidogrel in patients taking dual antiplatelet aggregation therapy (DAPT, ASA + clopidogrel or ticagrelor) undergoing coronary artery bypass grafting (CABG) on postoperative bleeding complications and need for mediastinal surgical re-exploration, focusing on the interval of discontinuation of DAPT.Material and methods: From January 2017 to January 2018, 190 patients underwent coronary artery bypass grafting with DAPT discontinuation 5 days (group 1, n = 82), 2-4 days (group 2, n = 84), or 0-1 days (group 3, n = 24) prior to CABG.Results: As compared to group 1, blood loss from chest tube drainages at 24 hours was significantly higher in groups 2 and 3 (480 +/- 238 vs. 512 +/- 209 vs. 640 +/- 253 ml; p = 0.007 and p = 0.016). Incidence of surgical re-exploration for bleeding was 1.2% in group 1, 2.4% in group 2, 12.5% in group 3 (p = 0.014). Independent predictors of surgical re-exploration were group 3 (p = 0.05; HR = 9.2) and preoperative increased value of creatinine serum level (p = 0.02; HR = 1.3). In group 3, the incidence of re-exploration was 5.6% (1/18) in patients taking ASA + clopidogrel, 33.3% (2/6) in those taking ASA + ticagrelor (HR-32), respectively (p < 0.001). Operative mortality was 1.2% in group 1, 1.2% in group 2, absent in group 3 (p = not significant).Conclusions: Continued DAPT intake until CABG shows a clear trend towards more bleeding complications when compared with its discontinuation. Major blood loss and surgical reexploration were not associated with an increased risk of operative mortality. Ticagrelor intake confers a higher risk of bleeding in comparison with clopidogrel; by stopping its intake at least 2 days prior to surgery, an increased risk of bleeding complications is not observed.
Nardi, P., Colella, D., Pisano, C., Bassano, C., Scafuri, A., Bertoldo, F., et al. (2019). Coronary artery bypass grafting on clopidogrel or ticagrelor therapy: interval of discontinuation and risk of bleeding. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA, 16(4), 166-172.
|Tipologia:||Articolo su rivista|
|Citazione:||Nardi, P., Colella, D., Pisano, C., Bassano, C., Scafuri, A., Bertoldo, F., et al. (2019). Coronary artery bypass grafting on clopidogrel or ticagrelor therapy: interval of discontinuation and risk of bleeding. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA, 16(4), 166-172.|
|Settore Scientifico Disciplinare:||Settore MED/23|
|Revisione (peer review):||Comitato scientifico|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.5114/kitp.2019.91386|
|Stato di pubblicazione:||Pubblicato|
|Data di pubblicazione:||2019|
|Titolo:||Coronary artery bypass grafting on clopidogrel or ticagrelor therapy: interval of discontinuation and risk of bleeding|
|Autori:||Nardi, P; Colella, D; Pisano, C; Bassano, C; Scafuri, A; Bertoldo, F; Buioni, D; Ruvolo, G|
|Appare nelle tipologie:||01 - Articolo su rivista|
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