CABG-Related Bleeding With Ticagrelor or Clopidogrel
What is the effect of a shorter discontinuation time before bypass surgery on the risk of major bleeding with ticagrelor or clopidogrel?
All acute coronary syndrome patients in Sweden on dual antiplatelet therapy with aspirin and ticagrelor (n = 1,266) or clopidogrel (n = 978) who underwent CABG during 2012–13 were included in a retrospective observational study. Logistic regression modeling was used to identify factors related to major bleeding and to compare incidence of bleeding between discontinuation groups.
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 hours before surgery. Within the ticagrelor group, there was no significant difference between discontinuation 72-120 or >120 hours 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 hours 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).
The authors concluded that the incidence of CABG-related major bleeding was high when ticagrelor/clopidogrel was discontinued <24 hours before surgery.
This study reports that discontinuation of the platelet inhibitor 3 days before surgery, as opposed to 5 days, did not increase the incidence of major bleeding complications in ticagrelor-treated patients, but increased the incidence in clopidogrel-treated patients. The incidence of CABG-related major bleeding was high when either ticagrelor or clopidogrel was discontinued <24 hours before surgery. In addition, a lower incidence of major bleeding complications was observed in ticagrelor-treated patients, except when the platelet inhibitor was discontinued <72 hours before surgery.
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