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Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study
Sahlgrenska University Hospital, Gothenburg, Sweden.
University Hospital, Uppsala, Sweden.
Blekinge Hospital, Karlskrona, Sweden.
Skåne University Hospital, Lund, Sweden.
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2016 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, no 2, 189-197 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: Excessive bleeding impairs outcome after coronary artery bypass grafting (CABG). Current guidelines recommend withdrawal of clopidogrel and ticagrelor 5 days (120 h) before elective surgery. Shorter discontinuation would reduce the risk of thrombotic events and save hospital resources, but may increase the risk of bleeding. We investigated whether a shorter discontinuation time before surgery increased the incidence of CABG-related major bleeding complications and compared ticagrelor- and clopidogrel-treated patients.

METHODS AND RESULTS: All acute coronary syndrome patients in Sweden on dual antiplatelet therapy with aspirin and ticagrelor (n = 1266) or clopidogrel (n = 978) who underwent CABG during 2012-13 were included in a retrospective observational study. The incidence of major bleeding complications according to the Bleeding Academic Research Consortium-CABG definition was 38 and 31%, respectively, when ticagrelor/clopidogrel was discontinued <24 h before surgery. Within the ticagrelor group, there was no significant difference between discontinuation 72-120 or >120 h before surgery [odds ratio (OR) 0.93 (95% confidence interval, CI, 0.53-1.64), P = 0.80]. In contrast, clopidogrel-treated patients had a higher incidence when discontinued 72-120 vs. >120 h before surgery (OR 1.71 (95% CI 1.04-2.79), P = 0.033). The overall incidence of major bleeding complications was lower with ticagrelor [12.9 vs. 17.6%, adjusted OR 0.72 (95% CI 0.56-0.92), P = 0.012].

CONCLUSION: The incidence of CABG-related major bleeding was high when ticagrelor/clopidogrel was discontinued <24 h before surgery. Discontinuation 3 days before surgery, as opposed to 5 days, did not increase the incidence of major bleeding complications with ticagrelor, but increased the risk with clopidogrel. The overall risk of major CABG-related bleeding complications was lower with ticagrelor than with clopidogrel.

Place, publisher, year, edition, pages
Oxford University Press, 2016. Vol. 37, no 2, 189-197 p.
Keyword [en]
Acute coronary syndrome; Bleeding complications; Cardiac surgery; Dual antiplatelet therapy
National Category
Cardiac and Cardiovascular Systems
URN: urn:nbn:se:liu:diva-124323DOI: 10.1093/eurheartj/ehv381ISI: 000370974300019PubMedID: 26330426OAI: diva2:897827

Funding agencies:  AstraZeneca; Swedish Heart and Lung Foundation [20120372, 2014021]

Available from: 2016-01-26 Created: 2016-01-26 Last updated: 2016-03-21

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Svedjeholm, Rolf
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Department of Thoracic and Vascular SurgeryLinköping University
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