Impact of preoperative dual antiplatelet therapy on bleeding complications in patients with acute coronary syndromes who undergo urgent coronary artery bypass grafting

Nagashima, Zenko; Tsukahara, Kengo; Uchida, Keiji; Hibi, Kiyoshi; Karube, Norihisa; Ebina, Toshiaki; Imoto, Kiyotaka; Kimura, Kazuo; Umemura, Satoshi

doi:10.1016/j.jjcc.2016.02.013

Cited by 14 publications

(14 citation statements)

References 32 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a study with 322 patients by Kim et al [20] , the authors reported that there was no association between use of clopidogrel within 5 days before CABG surgery and bleeding and reoperation. Also, in a study by Nagashima et al [21] , after comparing groups in which antithrombotic treatment was stopped and not stopped at 5-7 days before CABG, the authors found similar total volumes of intraoperative bleeding and bleeding at postoperative 48 hours between them. Similarly, they stated that they did not find significant difference between drain removal times and lengths of ICU and hospital stay.…”

Section: Discussionmentioning

confidence: 93%

Is Preoperative Clopidogrel Resistance a Predictor of Bleeding and Risks in Patients Undergoing Emergency CABG Surgery?

Kizilay¹,

Aslan²,

Vural³

et al. 2018

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

ObjectiveThe aims of this study were to determine whether the detection of preoperative clopidogrel resistance in patients undergoing cardiac surgery while using clopidogrel could play a guiding role in the prediction of postoperative excessive bleeding, transfusion requirements, and risks and to provide clinically significant data.MethodsTwo hundred and twenty-two patients [median age: 59.4 (38-83) years; 38 females] undergoing emergency and elective coronary artery bypass graft (CABG) surgeries in our clinic were evaluated prospectively. Patients with multiple systemic diseases, other than diabetes mellitus (DM) and hypertension (HT), were excluded. Patients receiving clopidogrel were also evaluated for clopidogrel resistance and grouped according to the results of this test. Assessments of platelet functions were performed by multiplate impedance aggregometry method and adenosine diphosphate test.ResultsThe use of postoperative fresh blood replacement and platelet transfusion was higher in patients receiving clopidogrel than in those not receiving it (P=0.001, P=0.018). DM, HT, myocardial infarction, and the number of presentation to the emergency room were significantly higher in patients receiving clopidogrel than in those not receiving it (P<0.05). No significant difference was determined between patients with and without clopidogrel resistance regarding the amount of bleeding during and after surgery, erythrocyte suspension and fresh-frozen plasma transfusion rates, preoperative troponin values, ejection fraction values, and length of hospital stays (P>0.05).ConclusionWe think that resistance studies in patients receiving clopidogrel before cardiac surgery are not efficient to predict bleeding and bleeding-related complications in patients undergoing emergency and elective CABG surgeries.

show abstract

Section: Discussionmentioning

confidence: 93%

Is Preoperative Clopidogrel Resistance a Predictor of Bleeding and Risks in Patients Undergoing Emergency CABG Surgery?

Kizilay¹,

Aslan²,

Vural³

et al. 2018

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

show abstract

“…It challenges its suitability for DAPT patients on a more routine basis. 3 Women with lower haemoglobin levels dominated the control group, which may have inflicted our results. Post hoc analysis showed no within-group inconsistencies for sex related to postoperative blood loss or transfusion demands.…”

Section: Discussionmentioning

confidence: 95%

“…DAPT has been shown to increase the risk of postoperative bleeding. 2,3 Preventive measures include withdrawal of antiplatelet therapy in good time before surgery, which for ticagrelor is at least 3 days. 4,5 When this is not possible, treatment of bleeding complications may require platelet transfusion, plasma, fibrinogen, fibrinolytic inhibitors and recombinant factor VIIa.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary bypass and dual antiplatelet therapy: a strategy to minimise transfusions and blood loss

et al. 2019

View full text Add to dashboard Cite

Background: Patients with preoperative dual antiplatelet therapy prior to coronary artery bypass surgery are at risk of bleeding and blood component transfusion. We hypothesise that an optimised cardiopulmonary bypass strategy reduces postoperative blood loss and transfusions. Methods: In total, 60 patients admitted for coronary artery bypass grafting with ticagrelor and aspirin medication withdrawn <96 hours before surgery were prospectively randomised into two equal sized groups. Cardiopulmonary bypass combined a closed Cortiva® heparin-coated circuit with low systemic heparinisation (activated clotting time < 250 seconds) and intraoperative cell salvage in the study group, whereas the control group used a Balance® coated open circuit, full systemic heparinisation (activated clotting time > 480 seconds) and conventional cardiotomy suction. This perfusion strategy was evaluated by the chest drain volume after 24 hours, perioperative haemoglobin and platelet loss accompanied by global coagulation assessments. Results: Patients in the study group demonstrated significantly better outcomes signified by lower blood loss 554 ± 224 versus 1,100 ± 989 mL (p < 0.001), reduced packed red cell transfusion 7% versus 53% (p < 0.001), reduced haemoglobin −28 ± 15 versus −40 ± 14 g/L (p = 0.004) and platelet loss −35 ± 36 versus −82 ± 67 × 109/L (p = 0.001). Indices of rotational thromboelastometry indicated shorter clotting times within the internal and external pathways. Adenosine diphosphate activated platelet function was within normal range based on Multiplate® aggregometry, while ROTEM® platelet analyses indicated inhibited function both preoperatively and post-bypass. Platelet inhibition by aspirin was verified throughout the perioperative period. Platelet function showed no intergroup differences. Conclusion: A stringent perfusion strategy reduced blood loss and transfusions in dual antiplatelet therapy patients requiring urgent surgery.

show abstract

“…Nevertheless, if transfusions were necessary, the amount of transfused erythrocyte units was rather high. This might be explained by the high rate of patients with DAPT at the time of surgery [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the unstable situation of AMI, the above-mentioned arguments against total arterial CABG might play an even more important role for decision-making, as patients with AMI undergoing urgent or emergent surgery would be expected to benefit from short operation times and rapid revascularization afforded by use of venous grafting. Furthermore, AMI patients are frequently administered dual antiplatelet therapy (DAPT) preoperatively, resulting in increased risk of bleeding complications [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Total arterial revascularization in patients with acute myocardial infarction – feasibility and outcomes

Grieshaber

Oster

Schneider

et al. 2018

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundIn acute situations such as acute myocardial infarction (AMI) with indication for coronary artery bypass grafting (CABG), total arterial revascularization (TAR) is often rejected in favour of saphenous vein (SV) grafting, which is assumed to allow for quicker vessel harvesting, a simpler anastomosis technique, and thus quicker revascularization and fewer bleeding complications. The aim of this study was to evaluate whether reluctance to apply TAR in AMI is still justified from a technical point of view in the current era and whether superiority of TAR results is also evident in emergency patients with AMI undergoing CABG.MethodsIn this retrospective analysis of 434 consecutive patients undergoing CABG for AMI with either TAR or with a combination of one internal mammary artery and SV grafts between 2008 and 2014, procedural data, short-term and mid-term outcome were compared. Propensity score matching of the groups was performed.ResultsAfter propensity score matching, 250 patients were included in the analysis (TAR group: n = 98; SV group n = 152). The procedural time (TAR group: 211 min vs. SV group: 200 min, p = 0.46) did not differ between the groups. Erythrocyte transfusion rates were higher in the SV group (76% vs. 57%; p < 0.001). Rates of re-exploration for bleeding did not differ. Thirty-day mortality rates were comparable (TAR group: 3.4% vs. SV group: 4.5%, p = 0.68). Kaplan-Meier analysis until 7 years postoperatively revealed a tendency for improved survival after TAR (75% vs. 62%; log-rank p = 0.12).ConclusionTAR neither impairs rapid revascularization nor reduces its safety in patients with AMI. It may result in improved long-term outcome and should be preferred in the clinical setting of AMI.

show abstract

Impact of preoperative dual antiplatelet therapy on bleeding complications in patients with acute coronary syndromes who undergo urgent coronary artery bypass grafting

Abstract: Preoperative DAPT increases the risk of CABG-related major bleeding in Japanese patients with ACS undergoing urgent CABG.

Cited by 14 publications

References 32 publications

Is Preoperative Clopidogrel Resistance a Predictor of Bleeding and Risks in Patients Undergoing Emergency CABG Surgery?

Is Preoperative Clopidogrel Resistance a Predictor of Bleeding and Risks in Patients Undergoing Emergency CABG Surgery?

Cardiopulmonary bypass and dual antiplatelet therapy: a strategy to minimise transfusions and blood loss

Total arterial revascularization in patients with acute myocardial infarction – feasibility and outcomes

Contact Info

Product

Resources

About