Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Thromb Res. 2022 Nov;219:70-76. doi: 10.1016/j.thromres.2022.09.010. Epub 2022 Sep 15.
Dual antiplatelet therapy (DAPT) consisting of acetylsalicylic acid and clopidogrel or ticagrelor increased bleeding complications in patients undergoing coronary artery bypass grafting (CABG). We aimed to compare the bleeding risks between patients treated with clopidogrel and ticagrelor preoperatively and investigate the influence of discontinuation of clopidogrel and ticagrelor on bleeding risk in off-pump CABG (OPCABG).
We conducted a retrospective analysis of patients with DAPT who underwent OPCABG. The propensity score matching was performed given the baseline differences between clopidogrel- and ticagrelor-treated patients. Bleeding was assessed by chest tube drainage volume and universal definition of perioperative bleeding.
This study included 836 patients. Five hundred and fifty patients were treated with clopidogrel and 286 patients treated with ticagrelor before surgery. After matching, 275 patients treated with clopidogrel and 275 patients with ticagrelor were included. There were no significant differences in bleeding between clopidogrel and ticagrelor group. Patients who discontinued clopidogrel before surgery <3 d had a higher risk of severe perioperative bleeding compared with those who discontinued ≥5 d (16.4 % vs. 5.0 %, P = 0.045). By contrast, the risk of severe perioperative bleeding was comparable among patients who discontinued ticagrelor for <3 d, ≥3-5 d and ≥5 d preoperatively (16.2 % vs. 9.1 % vs. 10.1 %, P = 0.317). The multivariable analysis confirmed that time since discontinuation (<3 d vs. ≥5 d: OR = 2.732, 95 % CI: 1.332-5.605, P = 0.006) but not the types of P2Y receptor antagonist was an independent predictor for severe perioperative bleeding.
There were no significant differences in severe perioperative bleeding between clopidogrel and ticagrelor groups. Discontinuation of clopidogrel <3 d before OPCABG increased the risk of severe perioperative bleeding.
双联抗血小板治疗（DAPT）包括阿司匹林和氯吡格雷或替格瑞洛，增加了接受冠状动脉旁路移植术（CABG）患者的出血并发症。我们旨在比较术前接受氯吡格雷和替格瑞洛治疗的患者的出血风险，并探讨停用氯吡格雷和替格瑞洛对非体外循环冠状动脉旁路移植术（OPCABG）出血风险的影响。
我们对接受 OPCABG 的 DAPT 患者进行了回顾性分析。由于氯吡格雷和替格瑞洛治疗的患者之间存在基线差异，因此进行了倾向评分匹配。通过胸腔引流量和围手术期出血的通用定义评估出血情况。
本研究纳入 836 例患者。550 例患者术前接受氯吡格雷治疗，286 例患者接受替格瑞洛治疗。匹配后，纳入 275 例接受氯吡格雷治疗和 275 例接受替格瑞洛治疗的患者。氯吡格雷和替格瑞洛组之间的出血无显著差异。术前停药<3 d 的患者与停药≥5 d 的患者相比，严重围手术期出血的风险更高（16.4% vs. 5.0%，P=0.045）。相比之下，术前停药<3 d、≥3-5 d 和≥5 d 的患者严重围手术期出血的风险相当（16.2% vs. 9.1% vs. 10.1%，P=0.317）。多变量分析证实，停药时间（<3 d 与≥5 d：OR=2.732，95%CI：1.332-5.605，P=0.006）而非 P2Y 受体拮抗剂类型是严重围手术期出血的独立预测因素。
氯吡格雷和替格瑞洛组严重围手术期出血无显著差异。OPCABG 术前停药<3 d 增加严重围手术期出血风险。
