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Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy.
Thorac Cardiovasc Surg. 2020 Jun 27 [Online ahead of print]TC

Abstract

OBJECTIVE

Patients with acute coronary syndrome are treated with dual antiplatelet therapy containing acetylsalicylic acid (ASA) and P2Y12 antagonists. In case of urgent coronary artery bypass grafting this might be associated with increasing risks of bleeding complications.

METHODS

Data from 1200 consecutive urgent operations between 2010 and 2018 were obtained from our institutional patient database. For this study off-pump surgery was excluded. The primary composite end point major bleeding consisted of at least one end point: transfusion ≥ 5 packed red blood cells within 24 hours, rethoracotomy due to bleeding, chest tube output >2000 mL within 24 hours. Demographic data, peri-, and postoperative variables and outcomes were compared between patients treated with mono antiplatelet therapy, ASA + clopidogrel (ASA-C) +ticagrelor (ASA-T) or +prasugrel (ASA-P) < 72 hours before surgery. Furthermore, we compared patients with dual antiplatelet therapy with ASA monotherapy.

RESULTS

From 1,086 patients, 475 (44%) received dual antiplatelet therapy. Three-hundred seventy-two received ASA-C (77.7%), 72 ASA-T (15%), and 31 ASA-P (6.5%). Major bleeding (44 vs. 23%, p < 0.0001) was more frequently in patients receiving dual therapy with higher rates of massive drainage loss within 24 hours (23 vs. 11%, p < 0.0001) of mass transfusion (34 vs. 16%, p < 0.0001) and rethoracotomy (10 vs. 5%, p = 0.002) when compared with ASA. In this analysis, ASA-T and ASA-P were not associated with higher bleeding complications compared with ASA-C.

CONCLUSION

Dual antiplatelet therapy is associated with higher rates of major bleeding. Further studies should examine the difference in the prevalence of major bleeding complications in the different dual antiplatelet therapy regimes in patients requiring urgent surgery.

Authors+Show Affiliations

Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany.Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany.Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany.Department of Cardiac Surgery, Kerckhoff Vascular Centre Bad Nauheim, Bad Nauheim, Hessen, Germany.Department of Cardiac Surgery, Kerckhoff Vascular Centre Bad Nauheim, Bad Nauheim, Hessen, Germany.Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany.Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32593177

Citation

Schlachtenberger, Georg, et al. "Major Bleeding After Surgical Revascularization With Dual Antiplatelet Therapy." The Thoracic and Cardiovascular Surgeon, 2020.
Schlachtenberger G, Deppe AC, Gerfer S, et al. Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy. Thorac Cardiovasc Surg. 2020.
Schlachtenberger, G., Deppe, A. C., Gerfer, S., Choi, Y. H., Zeriouh, M., Liakopoulos, O., & Wahlers, T. C. W. (2020). Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy. The Thoracic and Cardiovascular Surgeon. https://doi.org/10.1055/s-0040-1710508
Schlachtenberger G, et al. Major Bleeding After Surgical Revascularization With Dual Antiplatelet Therapy. Thorac Cardiovasc Surg. 2020 Jun 27; PubMed PMID: 32593177.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy. AU - Schlachtenberger,Georg, AU - Deppe,Antje Christin, AU - Gerfer,Stephen, AU - Choi,Yeong-Hoon, AU - Zeriouh,Mohamed, AU - Liakopoulos,Oliver, AU - Wahlers,Thorsten C W, Y1 - 2020/06/27/ PY - 2020/6/28/entrez PY - 2020/6/28/pubmed PY - 2020/6/28/medline JF - The Thoracic and cardiovascular surgeon JO - Thorac Cardiovasc Surg N2 - OBJECTIVE: Patients with acute coronary syndrome are treated with dual antiplatelet therapy containing acetylsalicylic acid (ASA) and P2Y12 antagonists. In case of urgent coronary artery bypass grafting this might be associated with increasing risks of bleeding complications. METHODS: Data from 1200 consecutive urgent operations between 2010 and 2018 were obtained from our institutional patient database. For this study off-pump surgery was excluded. The primary composite end point major bleeding consisted of at least one end point: transfusion ≥ 5 packed red blood cells within 24 hours, rethoracotomy due to bleeding, chest tube output >2000 mL within 24 hours. Demographic data, peri-, and postoperative variables and outcomes were compared between patients treated with mono antiplatelet therapy, ASA + clopidogrel (ASA-C) +ticagrelor (ASA-T) or +prasugrel (ASA-P) < 72 hours before surgery. Furthermore, we compared patients with dual antiplatelet therapy with ASA monotherapy. RESULTS: From 1,086 patients, 475 (44%) received dual antiplatelet therapy. Three-hundred seventy-two received ASA-C (77.7%), 72 ASA-T (15%), and 31 ASA-P (6.5%). Major bleeding (44 vs. 23%, p < 0.0001) was more frequently in patients receiving dual therapy with higher rates of massive drainage loss within 24 hours (23 vs. 11%, p < 0.0001) of mass transfusion (34 vs. 16%, p < 0.0001) and rethoracotomy (10 vs. 5%, p = 0.002) when compared with ASA. In this analysis, ASA-T and ASA-P were not associated with higher bleeding complications compared with ASA-C. CONCLUSION: Dual antiplatelet therapy is associated with higher rates of major bleeding. Further studies should examine the difference in the prevalence of major bleeding complications in the different dual antiplatelet therapy regimes in patients requiring urgent surgery. SN - 1439-1902 UR - https://www.unboundmedicine.com/medline/citation/32593177/Major_Bleeding_after_Surgical_Revascularization_with_Dual_Antiplatelet_Therapy L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0040-1710508 DB - PRIME DP - Unbound Medicine ER -
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