Is continuation of antiplatelets until coronary artery bypass safe in Asians?

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Pharmacology

Background:

• Controversies exist regarding the optimal timing for discontinuing antiplatelet therapy before coronary artery bypass grafting (CABG).
• Balancing the risk of bleeding against the risk of thrombotic events is crucial in managing patients undergoing CABG.

Purpose of the Study:

• To evaluate the impact of different antiplatelet discontinuation strategies before CABG on perioperative bleeding and major adverse cardiovascular events (MACE).
• To assess these effects specifically in Asian patients at a single center in Singapore.

Main Methods:

• Retrospective study of 402 patients undergoing CABG.
• Patients were categorized into four groups based on the timing of antiplatelet discontinuation: no antiplatelets, stopped 5-7 days prior, 2-4 days prior, and 0-1 day prior.
• Outcomes assessed included perioperative bleeding, blood product transfusion, intensive care unit (ICU) stay, and 1-year MACE.

Main Results:

• Stopping antiplatelets 0-1 day before surgery (Group D) was associated with longer ICU stays and increased intraoperative transfusions compared to stopping 5-7 days prior (Group B).
• The 1-year MACE rate was higher in patients who received no antiplatelets (Group A) and those who stopped 0-1 day prior (Group D).
• Antiplatelet therapy within 24 hours of surgery predicted intraoperative transfusion but not 1-year MACE. Aspirin monotherapy resulted in less bleeding than dual antiplatelet therapy.

Conclusions:

• Continuing antiplatelet therapy until two days before CABG in Asian patients appears safe, without increasing bleeding or transfusion risks.
• Discontinuing antiplatelets within 24 hours of surgery may be linked to higher MACE, bleeding, and transfusion rates.
• Patients not receiving antiplatelet treatment showed increased 30-day and 1-year MACE rates.