Transfusion outcomes in patients undergoing coronary artery bypass grafting treated with prasugrel or clopidogrel:
Lawrence T Goodnough1, Peter K Smith2, Jerrold H Levy3
1Departments of Pathology and Medicine, Stanford University School of Medicine, Stanford, Calif.
Insights
Prasugrel use in coronary artery bypass grafting patients showed increased chest tube drainage and platelet transfusions compared to clopidogrel. However, red blood cell transfusions and overall blood exposure did not significantly differ between the dual antiplatelet therapy groups.
Area of Science:
- Cardiology
- Pharmacology
- Transfusion Medicine
Background:
- Dual antiplatelet therapy (DAPT) with prasugrel or clopidogrel is standard for acute coronary syndromes.
- Bleeding and transfusion requirements post-coronary artery bypass grafting (CABG) are significant concerns with DAPT.
Purpose of the Study:
- To compare transfusion requirements between patients receiving prasugrel versus clopidogrel undergoing CABG.
- To assess risk-adjusted differences in transfusion needs and blood product exposure.
Main Methods:
- Retrospective analysis of 422 patients undergoing isolated CABG from the TRITON-TIMI 38 trial.
- Comparison of transfusion rates, chest tube drainage, and blood donor exposure between prasugrel and clopidogrel cohorts.
Main Results:
- No significant difference in baseline transfusion risk scores between groups.
- Prasugrel cohort had higher 12-hour chest tube drainage and platelet transfusion rates.
- No significant differences in red blood cell transfusions, total hemostatic components, or total blood donor exposure.
Conclusions:
- Prasugrel use was associated with increased chest tube drainage and platelet transfusions post-CABG compared to clopidogrel.
- No significant differences in red blood cell transfusions or overall blood donor exposure were observed.
- Risk-adjusted analysis did not link total donor exposure to increased mortality.
Objective:
Coronary artery bypass grafting-related bleeding and associated transfusion is a concern with dual antiplatelet therapy in patients with acute coronary syndromes. The objective of the present study was to characterize a potential risk-adjusted difference in transfusion requirements between prasugrel and clopidogrel cohorts.
Methods:
The data from 422 patients undergoing isolated coronary artery bypass grafting from the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel Thrombolysis In Myocardial Infarction 38 were analyzed retrospectively.
Results:
We found no difference in baseline transfusion risk scores between cohorts. As predicted, the number of units of red blood cells transfused perioperatively correlated with the transfusion risk score (P < .0001). Overall, the 12-hour chest tube drainage volumes and platelet transfusion rates in the prasugrel cohort were significantly greater. However, no statistically significant differences were found in the number of red blood cell transfusions, total hemostatic components transfused, or total blood donor exposure. A significantly greater number of platelet units were transfused postoperatively in the prasugrel patients who underwent surgery within 5 days or less after withdrawal of drug. In an analysis adjusted for the predicted risk of mortality, total donor exposure was not associated with increased mortality.
Conclusions:
The use of prasugrel compared with clopidogrel was associated with greater 12-hour chest tube drainage volumes and platelet transfusion rates but without any significant differences in red blood cell transfusions, total hemostatic components transfused, or total blood donor exposure.
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