The association between a three-day ticagrelor discontinuation and perioperative bleeding complications

Kremke, Michael; Gissel, Marie Storebjerg; Jensen, Marie Louise Slott; Thomassen, Sisse Anette; Jakobsen, Carl-Johan

doi:10.1093/ejcts/ezy355

Cited by 15 publications

(18 citation statements)

References 20 publications

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“…According to the widely used TIMI bleeding criteria in the setting of CABG, 8 the BARC criteria, 10 and the UDP criteria 11 and referring to the novel criteria compiled by Kremke et al, 9 we observed markedly elevated risk of bleeding complications in patients taking DAPT in general. Straus et al revealed no significant bleeding complications between Aspirin and DAPT.…”

Section: Discussionmentioning

confidence: 76%

“…A proper discontinuation of the P2Y12 antagonist does not yield a higher risk for postoperative major bleeding compli-cations. 5,9,13 However, urgent or even salvage CABG has to be performed under DAPT that contributes the risk for MB complication. 14 Miceli et al found that administration of ASA in combination with clopidogrel at time of the surgery finding increases the risk of bleeding complications.…”

Section: Discussionmentioning

confidence: 99%

“…These bleeding characteristics are according to the majority of published criteria on this topic: like the well-established thrombolysis in myocardial infarction (TIMI) criteria, the BARC (Bleeding Academic Research Consortium) criteria and the UDP (universal definition of perioperative bleeding in adult cardiac surgery) criteria. [8][9][10][11] We assumed for the composite outcome and primary end point MB, the occurrence of at least one of the following criteria:…”

Section: End Pointsmentioning

confidence: 99%

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Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy

Schlachtenberger

Deppe

Gerfer

et al. 2020

Thorac Cardiovasc Surg

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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.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: End Pointsmentioning

confidence: 99%

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Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy

Schlachtenberger

Deppe

Gerfer

et al. 2020

Thorac Cardiovasc Surg

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“…[2][3][4] On the other hand, it can heighten the risk of perioperative bleeding, particularly after cardiac surgery, as demonstrated in case reports 5,6 and observational studies. 18,10 There is strong evidence that ongoing dual antiplatelet therapy at the time of emergency cardiac surgery is associated with a greater incidence of major bleeding, larger transfusion requirement, 19 and greater odds of postoperative stroke and acute kidney injury. 20 Indeed, ticagrelor administered before repair of acute aortic dissection resulted in a larger volume of intraoperative blood loss and greater mortality over clopidogrel (38% v 18%; p = 0.19), although this difference was not significant owing to limited sample size.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 A 5-day waiting period is recommended for a full recovery, 9 but recently it was shown that a 3-day cessation before cardiac surgery was sufficient to avoid increased incidence of major bleeding or mediastinal reexploration. 8,[10][11][12] Platelet transfusion is the logical choice to mitigate ticagrelor-associated hemorrhage. The efficacy of platelet transfusion is presumed to be dependent on the time from last intake and administered dose of ticagrelor because transfused platelets could be affected by circulating ticagrelor and AR-C124910XX.…”

mentioning

confidence: 99%