Risk Factors for Postoperative Events in Patients on Antiplatelet Therapy Undergoing Off-Pump Coronary Artery Bypass...

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) is crucial for preventing thrombotic events but poses bleeding risks.
• Off-pump coronary artery bypass graft (CABG) surgery requires careful management of antiplatelet agents.
• Understanding the optimal timing for DAPT cessation before CABG is critical for patient safety.

Purpose of the Study:

• To assess risk factors for adverse events after off-pump CABG in patients on DAPT.
• To determine the association between DAPT discontinuation timing and postoperative bleeding and ischemia.
• To evaluate the impact of bleeding complications on mortality following CABG.

Main Methods:

• Retrospective review of 2012 patients undergoing off-pump CABG between 2013 and 2017.
• Analysis of patients who discontinued DAPT (clopidogrel and aspirin) ≤5 days before surgery.
• Multivariable logistic regression used to identify risk factors for bleeding events and perioperative myocardial ischemia.

Main Results:

• Major bleeding events (BARC type 4) occurred in 17.6% of patients.
• Discontinuing DAPT <3 days before CABG significantly increased postoperative bleeding risk (e.g., day 0: aOR 2.45).
• Bleeding complications were associated with a substantially increased risk of mortality (aOR 13.14).

Conclusions:

• DAPT should ideally be discontinued at least 3 days before CABG surgery.
• This timing minimizes the risk of postoperative bleeding, myocardial ischemia, and death.
• Optimizing DAPT cessation protocols is essential for improving outcomes in off-pump CABG patients.