Impact of preoperative dual antiplatelet therapy on bleeding complications in patients with acute coronary syndromes who undergo urgent coronary artery bypass grafting

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• 作者：Zenko Nagashima ; MD^a ; Kengo Tsukahara ; MD^a ; ^{k-tsuka@yokohama-cu.ac.jp} ; Keiji Uchida ; MD^b ; Kiyoshi Hibi ; MD ; FJCC^a ; Norihisa Karube ; MD^b ; Toshiaki Ebina ; MD^a ; Kiyotaka Imoto ; MD^b ; Kazuo Kimura ; MD ; FJCC^a ; Satoshi Umemura ; MD^c
• 关键词：Bleeding ; Coronary artery bypass grafting ; Platelet inhibitors ; Coronary heart disease
• 刊名：Journal of Cardiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：69
• 期：1
• 页码：156-161
• 全文大小：363 K
• 卷排序：69

文摘

A 5- to 7-day washout period before coronary artery bypass grafting (CABG) is recommended for patients who have recently received a thienopyridine derivative; however, data supporting this guideline recommendation are lacking in Japanese patients.MethodsUrgent isolated CABG was performed in 130 consecutive patients with acute coronary syndromes (ACS) (101 men; mean age, 69 years). Urgent CABG was defined as operation performed within 5 days after coronary angiography. All patients continued to receive aspirin 100 mg/day. The subjects were retrospectively divided into 2 groups: 30 patients with preoperative thienopyridine (clopidogrel in 15 patients, ticlopidine in 15) exposure within 5 days [dual antiplatelet therapy (DAPT) group] and 100 patients without exposure [single antiplatelet therapy (SAPT) group].ResultsAlthough the DAPT group had a higher proportion of patients who received perioperative platelet transfusions than the SAPT group (50% vs. 18%, p < 0.001), intraoperative bleeding (median, 1100 ml; interquartile range, 620–1440 vs. 920 ml; 500–1100) and total drain output within 48 h after surgery (577 ± 262 vs. 543 ± 277 ml) were similar. CABG-related major bleeding, which was defined as type 4 or 5 bleeding according to the Bleeding Academic Research Consortium definitions, occurred in a significantly higher proportion of patients in the DAPT group than in the SAPT group (20% vs. 3%, p = 0.005). This difference in major bleeding was driven mainly by the higher rate of transfusion of ≥5 U red blood cells within a 48-h period in the DAPT group (13% vs. 1%, p = 0.01). There was no significant difference in the 30-day composite endpoint including death, myocardial (re)infarction, ischemic stroke, and refractory angina between the DAPT group and SAPT group (17% vs. 19%).ConclusionsPreoperative DAPT increases the risk of CABG-related major bleeding in Japanese patients with ACS undergoing urgent CABG.