uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study
Sahlgrens Univ Hosp, Dept Cardiothorac Surg, SE-41345 Gothenburg, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Blekinge Hosp, Dept Cardiothorac Surg, Karlskrona, Sweden..
Skane Univ Hosp, Dept Cardiothorac Surg, Lund, Sweden..
Show others and affiliations
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
Resource type
Text
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
2016. Vol. 37, no 2, 189-197 p.
Keyword [en]
Dual antiplatelet therapy, Acute coronary syndrome, Bleeding complications, Cardiac surgery
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-282391DOI: 10.1093/eurheartj/ehv381ISI: 000370974300019PubMedID: 26330426OAI: oai:DiVA.org:uu-282391DiVA: diva2:917030
Funder
AstraZenecaSwedish Heart Lung Foundation, 20120372Swedish Heart Lung Foundation, 2014021
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2017-11-30Bibliographically approved

Open Access in DiVA

fulltext(282 kB)175 downloads
File information
File name FULLTEXT01.pdfFile size 282 kBChecksum SHA-512
a390c08885bb953b099c88fd8684451a52e9f7d1ae52c7aa24114d1055823052a21defa455e6c9454c5c688b603d0ec26e34aa0ec2724d389190a649da4fb473
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Authority records BETA

Jideus, Lena

Search in DiVA

By author/editor
Jideus, Lena
By organisation
Thoracic Surgery
In the same journal
European Heart Journal
SurgeryCardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar
Total: 175 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 589 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf