Universität zu Köln

Schlachtenberger, Georg ORCID: 0000-0001-7118-8432, Deppe, Antje Christin, Gerfer, Stephen, Choi, Yeong-Hoon, Zeriouh, Mohamed, Liakopoulos, Oliver and Wahlers, Thorsten C. W. (2020). Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy. Thorac. Cardiovasc. Surg., 68 (8). S. 714 - 723. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-1902

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Abstract

Objective Patients with acute coronary syndrome are treated with dual antiplatelet therapy containing acetylsalicylic acid (ASA) and P2Y12 antagonists. In case of urgent coronary artery bypass grafting this might be associated with increasing risks of bleeding complications. Methods Data from 1200 consecutive urgent operations between 2010 and 2018 were obtained from our institutional patient database. For this study off-pump surgery was excluded. The primary composite end point major bleeding consisted of at least one end point: transfusion >= 5 packed red blood cells within 24hours, rethoracotomy due to bleeding, chest tube output >2000mL within 24hours. Demographic data, peri-, and postoperative variables and outcomes were compared between patients treated with mono antiplatelet therapy, ASA+clopidogrel (ASA-C) +ticagrelor (ASA-T) or +prasugrel (ASA-P)<72hours before surgery. Furthermore, we compared patients with dual antiplatelet therapy with ASA monotherapy. Results From 1,086 patients, 475 (44%) received dual antiplatelet therapy. Three-hundred seventy-two received ASA-C (77.7%), 72 ASA-T (15%), and 31 ASA-P (6.5%). Major bleeding (44 vs. 23%, p <0.0001) was more frequently in patients receiving dual therapy with higher rates of massive drainage loss within 24hours (23 vs. 11%, p <0.0001) of mass transfusion (34 vs. 16%, p <0.0001) and rethoracotomy (10 vs. 5%, p =0.002) when compared with ASA. In this analysis, ASA-T and ASA-P were not associated with higher bleeding complications compared with ASA-C. Conclusion Dual antiplatelet therapy is associated with higher rates of major bleeding. Further studies should examine the difference in the prevalence of major bleeding complications in the different dual antiplatelet therapy regimes in patients requiring urgent surgery.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schlachtenberger, Georg UNSPECIFIED orcid.org/0000-0001-7118-8432 UNSPECIFIED Deppe, Antje Christin UNSPECIFIED UNSPECIFIED UNSPECIFIED Gerfer, Stephen UNSPECIFIED UNSPECIFIED UNSPECIFIED Choi, Yeong-Hoon UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeriouh, Mohamed UNSPECIFIED UNSPECIFIED UNSPECIFIED Liakopoulos, Oliver UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten C. W. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-310027
DOI:	10.1055/s-0040-1710508
Journal or Publication Title:	Thorac. Cardiovasc. Surg.
Volume:	68
Number:	8
Page Range:	S. 714 - 723
Date:	2020
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1439-1902
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE MYOCARDIAL-INFARCTION; CLOPIDOGREL; TRANSFUSION; PRASUGREL; COMPLICATIONS; TICAGRELOR; OUTCOMES; TIMI; MORTALITY; ELEVATION Multiple languages Cardiac & Cardiovascular Systems; Respiratory System; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/31002