부산대학교 도서관

Increased bleeding risks have been documented in patients exposed to P2Y 12 inhibitors within 5 days of coronary artery bypass surgery (CABG). This study aimed to determine the relative CABG bleeding risks of clopidogrel versus ticagrelor exposure and the proper time course of ticagrelor discontinuation prior to surgery. Clinical outcomes were assessed in 2075 isolated CABG patients, including 375 who had received P2Y 12 inhibitors within 5 days of surgery (155 clopidogrel, 213 ticagrelor, 7 prasugrel). BARC-4 CABG bleeding complications and perioperative blood product usage were assessed in propensity-matched P2Y 12 -inhibited and non-P2Y 12 -inhibited cohorts. P2Y 12 -inhibited patients (n = 375) in comparison to matched non-P2Y 12 -inhibited patients (n = 1138) had higher rates of re-operation for bleeding (3.8 % vs 1.3 %, p = 0.003), postoperative red blood cell transfusion ≥5 units (5.7 % vs 2.7 %, p = 0.007), and intraoperative and postoperative blood product utilization (42.3 % vs 27.1 %, p < 0.001; 41.8 % vs 32.2 %, p < 0.001, respectively). Univariate predictors of BARC-4 bleeding included clopidogrel (OR: 2.145, 95 % CI: 1.131–4.067, p = 0.019) and ticagrelor discontinued within 3 days of surgery (OR: 2.153, 95 % CI: 1.003–4.169, p = 0.049). Multivariate logistic regression demonstrated that only clopidogrel exposure was an independent BARC-4 bleeding predictor (OR: 1.850, 95 % CI: 1.007–3.398, p = 0.048). Unadjusted ticagrelor patients with drug discontinuation 4–5 days prior to CABG only demonstrated higher rates of perioperative platelet transfusion, without additional signs of excessive bleeding. Clopidogrel exposure within 5 days of CABG is an independent predictor of BARC-4 bleeding, whereas major ticagrelor bleeding effects are confined to drug exposure within 3 days of surgery. • Perioperative bleeding complications were assessed in 2,075 patients undergoing isolated CABG. • The study group included 375 patients that had received P2Y 12 inhibitor therapy within 5 days of surgery. • Propensity-matched P2Y 12 -inhibited patients had increased BARC-4 bleeding and perioperative blood product utilization. • Clopidogrel exposure within 5 days of CABG was an independent predictor of BARC-4 bleeding. • Major ticagrelor bleeding effects were confined to drug exposure within 3 days of surgery. [ABSTRACT FROM AUTHOR]