How Do Type of Preoperative P2Y
Aged
Clopidogrel
/ administration & dosage
Coronary Artery Bypass
Female
Hemorrhage
/ epidemiology
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors
/ administration & dosage
Prasugrel Hydrochloride
/ administration & dosage
Preoperative Period
Prospective Studies
Purinergic P2Y Receptor Antagonists
/ administration & dosage
Ticagrelor
/ administration & dosage
Time Factors
Withholding Treatment
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
05
11
2019
revised:
02
04
2020
accepted:
23
04
2020
pubmed:
23
6
2020
medline:
29
1
2021
entrez:
23
6
2020
Statut:
ppublish
Résumé
Despite recommendations for standardized preoperative waiting of at least 3, 5, and 7 days for ticagrelor, clopidogrel, and prasugrel, respectively, there is still substantial interinstitutional variation in preoperative discontinuation of dual antiplatelet therapy in patients needing coronary artery bypass grafting (CABG). In 299 patients undergoing CABG with or without valve intervention less than 7 days after last P2Y A total of 83% of patients underwent CABG less than 48 hours after last drug intake. Calculated blood loss was lower in patients taking clopidogrel as compared with prasugrel or ticagrelor (1063 mL [690 to 1394 mL] vs 1351 mL [876 to 1829 mL] vs 1330 mL [994 to 1691 mL]; P < .001). Overall, 135 (45%) patients sustained BARC-4 bleeding; the incidence differed among the groups (P = .015) and was significantly higher in prasugrel-treated patients, as compared with clopidogrel-treated patients. In multivariable linear regression analysis, European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), aspirin dose, cardiopulmonary bypass time, drug withdrawal time, and type of P2Y Exposure to prasugrel and ticagrelor 24 hours or less before CABG increases both calculated blood loss and BARC-4 bleeding as compared with clopidogrel. Although discontinuation for longer than 48 hours substantially reduced calculated blood loss and BARC-4 bleeding across all P2Y
Sections du résumé
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 interinstitutional variation in preoperative discontinuation of dual antiplatelet therapy in patients needing coronary artery bypass grafting (CABG).
METHODS
In 299 patients undergoing CABG with or without valve intervention less than 7 days after last P2Y
RESULTS
A total of 83% of patients underwent CABG less than 48 hours after last drug intake. Calculated blood loss was lower in patients taking clopidogrel as compared with prasugrel or ticagrelor (1063 mL [690 to 1394 mL] vs 1351 mL [876 to 1829 mL] vs 1330 mL [994 to 1691 mL]; P < .001). Overall, 135 (45%) patients sustained BARC-4 bleeding; the incidence differed among the groups (P = .015) and was significantly higher in prasugrel-treated patients, as compared with clopidogrel-treated patients. In multivariable linear regression analysis, European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), aspirin dose, cardiopulmonary bypass time, drug withdrawal time, and type of P2Y
CONCLUSIONS
Exposure to prasugrel and ticagrelor 24 hours or less before CABG increases both calculated blood loss and BARC-4 bleeding as compared with clopidogrel. Although discontinuation for longer than 48 hours substantially reduced calculated blood loss and BARC-4 bleeding across all P2Y
Identifiants
pubmed: 32565086
pii: S0003-4975(20)30940-1
doi: 10.1016/j.athoracsur.2020.04.126
pii:
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Purinergic P2Y Receptor Antagonists
0
Clopidogrel
A74586SNO7
Prasugrel Hydrochloride
G89JQ59I13
Ticagrelor
GLH0314RVC
Types de publication
Comparative Study
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
77-84Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.