Bleeding in Patients Treated With Ticagrelor or Clopidogrel Before Coronary Artery Bypass Grafting

Abstract

<div><div><div><h3>Background</h3><p>We evaluated perioperative bleeding after <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/coronary-artery-bypass-graft" title="Learn more about Coronary Artery Bypass Graft from ScienceDirect's AI-generated Topic Pages">coronary artery bypass grafting</a> (CABG) in patients preoperatively treated with <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/ticagrelor" title="Learn more about Ticagrelor from ScienceDirect's AI-generated Topic Pages">ticagrelor</a> or <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/clopidogrel" title="Learn more about Clopidogrel from ScienceDirect's AI-generated Topic Pages">clopidogrel</a>, stratified by discontinuation of these P2Y₁₂ inhibitors.</p></div><div><h3>Methods</h3><p>All patients from the prospective, European Multicenter Registry on Coronary Artery Bypass Grafting (E-CABG) treated with ticagrelor or clopidogrel undergoing isolated primary CABG were eligible. The primary outcome measure was severe or massive bleeding defined according to the Universal Definition of Perioperative Bleeding, stratified by P2Y₁₂ inhibitor discontinuation. Secondary outcome measures included four additional definitions of major bleeding. <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/propensity-score-matching" title="Learn more about Propensity Score Matching from ScienceDirect's AI-generated Topic Pages">Propensity score matching</a> was performed to adjust for differences in preoperative and perioperative covariates.</p></div><div><h3>Results</h3><p>Of 2,311 patients who were included, 1,293 (55.9%) received clopidogrel and 1,018 (44.1%) ticagrelor preoperatively. Mean time between discontinuation and the operation was 4.5 ± 3.2 days for clopidogrel and 4.9 ± 3.0 days for ticagrelor. In the propensity score–matched cohort, ticagrelor-treated patients had a higher incidence of major bleeding according to Universal Definition of Perioperative Bleeding when ticagrelor was discontinued 0 to 2 days compared with 3 days before the operation (16.0% vs 2.7%, <em>p</em> = 0.003). Clopidogrel-treated patients had a higher incidence of major bleeding according to the Universal Definition of Perioperative Bleeding when clopidogrel was discontinued 0 to 3 days compared with 4 to 5 days before the operation (15.6% vs 8.3%, <em>p</em> = 0.031).</p></div><div><h3>Conclusions</h3><p>In patients receiving ticagrelor 2 days before CABG and in those receiving clopidogrel 3 days before CABG, there was an increased rate of severe bleeding. Postponing nonemergent CABG for at least 3 days after discontinuation of ticagrelor and 4 days after clopidogrel should be considered.</p></div></div></div>