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How do type of preoperative P2Y12 receptor inhibitor and withdrawal time affect bleeding.
Ann Thorac Surg. 2020 Jun 18 [Online ahead of print]AT

Abstract

BACKGROUND

Despite recommendations for standardized preoperative waiting of at least 3, 5, and 7 days for ticagrelor, clopidogrel, and prasugrel, respectively, there is still substantial inter-institutional variation in preoperative discontinuation of dual antiplatelet therapy in patients needing coronary artery bypass grafting (CABG).

METHODS

In 299 patients undergoing CABG ± valve intervention <7 days after last P2Y12 receptor inhibition, we evaluated calculated red blood cell loss. and Bleeding Academic Research Consortium (BARC)-4 bleeding.

RESULTS

83% of patients underwent CABG within <48 hours of last drug intake. Calculated blood loss was lower in patients on clopidogrel as compared to prasugrel or ticagrelor [1063 (690-1394) vs. 1351 (876-1829) vs. 1330 (994-1691) ml, p<0.001]. Overall, 135 (45%) patients sustained BARC-4 bleeding; incidence differed between groups (p=0.015) and was significantly higher in prasugrel-, as compared to clopidogrel-treated patients. In multivariable linear regression analysis, EuroSCORE II, aspirin dose, cardio-pulmonary-bypass time, drug withdrawal time, and type of P2Y12 receptor inhibitor were significantly associated with RBC loss. Compared to 0-24, >48 hours preoperative discontinuation substantially reduced calculated blood loss by 37-48% und BARC-4 bleeding by 58-71%, depending on P2Y12 receptor inhibitor.

CONCLUSIONS

Exposure to prasugrel and ticagrelor within 24 hours before CABG increases both calculated blood loss and BARC-4 bleeding as compared to clopidogrel. Although a >48 hours discontinuation substantially reduced calculated blood loss and BARC-4 bleeding across all P2Y12 receptor inhibitors, our single center data further support strict adherence to the 2017 guidelines whenever justified by stable hemodynamics and non-jeopardized myocardium.

Authors+Show Affiliations

Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria; Department of Cardiac surgery, Medical University of Graz, Austria. Electronic address: a.voetsch@salk.at.Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria.Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria.Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria.Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32565086

Citation

Voetsch, Andreas, et al. "How Do Type of Preoperative P2Y12 Receptor Inhibitor and Withdrawal Time Affect Bleeding." The Annals of Thoracic Surgery, 2020.
Voetsch A, Pregartner G, Berghold A, et al. How do type of preoperative P2Y12 receptor inhibitor and withdrawal time affect bleeding. Ann Thorac Surg. 2020.
Voetsch, A., Pregartner, G., Berghold, A., Seitelberger, R., Schoerghuber, M., Toller, W., & Mahla, E. (2020). How do type of preoperative P2Y12 receptor inhibitor and withdrawal time affect bleeding. The Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2020.04.126
Voetsch A, et al. How Do Type of Preoperative P2Y12 Receptor Inhibitor and Withdrawal Time Affect Bleeding. Ann Thorac Surg. 2020 Jun 18; PubMed PMID: 32565086.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How do type of preoperative P2Y12 receptor inhibitor and withdrawal time affect bleeding. AU - Voetsch,Andreas, AU - Pregartner,Gudrun, AU - Berghold,Andrea, AU - Seitelberger,Rainald, AU - Schoerghuber,Michael, AU - Toller,Wolfgang, AU - Mahla,Elisabeth, Y1 - 2020/06/18/ PY - 2019/11/05/received PY - 2020/04/02/revised PY - 2020/04/23/accepted PY - 2020/6/23/entrez KW - CABG KW - P2Y(12) receptor inhibitors KW - bleeding JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. N2 - BACKGROUND: Despite recommendations for standardized preoperative waiting of at least 3, 5, and 7 days for ticagrelor, clopidogrel, and prasugrel, respectively, there is still substantial inter-institutional variation in preoperative discontinuation of dual antiplatelet therapy in patients needing coronary artery bypass grafting (CABG). METHODS: In 299 patients undergoing CABG ± valve intervention <7 days after last P2Y12 receptor inhibition, we evaluated calculated red blood cell loss. and Bleeding Academic Research Consortium (BARC)-4 bleeding. RESULTS: 83% of patients underwent CABG within <48 hours of last drug intake. Calculated blood loss was lower in patients on clopidogrel as compared to prasugrel or ticagrelor [1063 (690-1394) vs. 1351 (876-1829) vs. 1330 (994-1691) ml, p<0.001]. Overall, 135 (45%) patients sustained BARC-4 bleeding; incidence differed between groups (p=0.015) and was significantly higher in prasugrel-, as compared to clopidogrel-treated patients. In multivariable linear regression analysis, EuroSCORE II, aspirin dose, cardio-pulmonary-bypass time, drug withdrawal time, and type of P2Y12 receptor inhibitor were significantly associated with RBC loss. Compared to 0-24, >48 hours preoperative discontinuation substantially reduced calculated blood loss by 37-48% und BARC-4 bleeding by 58-71%, depending on P2Y12 receptor inhibitor. CONCLUSIONS: Exposure to prasugrel and ticagrelor within 24 hours before CABG increases both calculated blood loss and BARC-4 bleeding as compared to clopidogrel. Although a >48 hours discontinuation substantially reduced calculated blood loss and BARC-4 bleeding across all P2Y12 receptor inhibitors, our single center data further support strict adherence to the 2017 guidelines whenever justified by stable hemodynamics and non-jeopardized myocardium. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/32565086/How_do_type_of_preoperative_P2Y12_receptor_inhibitor_and_withdrawal_time_affect_bleeding L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(20)30940-1 DB - PRIME DP - Unbound Medicine ER -
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