Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy

Georg Schlachtenberger; Antje Christin Deppe; Stephen Gerfer; Yeong-Hoon Choi; Mohamed Zeriouh; Oliver Liakopoulos; Thorsten C.W. Wahlers

doi:10.1055/s-0040-1710508

The Thoracic and Cardiovascular Surgeon, Inhaltsverzeichnis

Thorac Cardiovasc Surg 2020; 68(08): 714-722
DOI: 10.1055/s-0040-1710508

Original Cardiovascular

Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy

Georg Schlachtenberger ^*

¹Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany

,

Antje Christin Deppe‡^*

¹Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany

,

Stephen Gerfer

¹Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany

,

Yeong-Hoon Choi

²Department of Cardiac Surgery, Kerckhoff Vascular Centre Bad Nauheim, Bad Nauheim, Hessen, Germany

,

Mohamed Zeriouh

²Department of Cardiac Surgery, Kerckhoff Vascular Centre Bad Nauheim, Bad Nauheim, Hessen, Germany

,

Oliver Liakopoulos

¹Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany

,

Thorsten C.W. Wahlers

¹Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany

› Institutsangaben

Abstract

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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.

Keywords

coronary artery bypass grafts surgery - CABG - myocardial infarction (includes complications; e.g. - rupture) - blood - antiplatelet

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