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Published on: March 15, 2022
Impact of preoperative antithrombotic therapy in patients undergoing elective isolated coronary artery bypass
Gijs J van Steenbergen1, Albert H M van Straten1, Serhat Kabak1
1Cardiothoracic surgery department, Catharina Heart Centre, Catharina Hospital, ZA Eindhoven, Netherlands.
Insights
Patients undergoing coronary artery bypass grafting (CABG) on antithrombotic (AT) therapy other than acetylsalicylic acid (ASA) monotherapy face higher risks of bleeding and blood transfusions. This risk is amplified when AT therapy deviates from established guidelines.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Patients undergoing coronary artery bypass grafting (CABG) often require antithrombotic (AT) therapy to prevent thrombotic events.
- The choice of AT regimen, including acetylsalicylic acid (ASA) monotherapy versus other ATs, may influence perioperative outcomes.
- Understanding these differences is crucial for optimizing patient care and surgical planning in elective CABG procedures.
Purpose of the Study:
- To compare clinical outcomes between patients on ASA monotherapy and those on alternative AT regimens undergoing elective CABG.
- To evaluate the impact of guideline adherence on outcomes in patients receiving non-ASA AT therapy.
- To identify potential risks associated with different AT strategies in the context of CABG surgery.
Main Methods:
- Retrospective analysis of 1068 patients undergoing elective isolated CABG between 2017 and 2019.
- Primary endpoints included re-exploration for bleeding and postoperative blood product transfusion.
- Propensity matching was employed to compare outcomes between ASA monotherapy and other AT regimens, as well as guideline-adherent and non-adherent subgroups.
Main Results:
- Patients on AT regimens other than ASA monotherapy showed a significantly higher risk of re-exploration for bleeding (6.6% vs 2.0%) and increased blood product use (37.5% vs 20.3%).
- In a subgroup analysis, non-adherence to AT therapy guidelines was associated with increased re-exploration rates (10.7% vs 3.3%) and higher blood product utilization (51.6% vs 25.4%).
- No significant differences were observed in secondary endpoints such as 30-day mortality, stroke, myocardial infarction, or hospitalization duration.
Conclusions:
- Preoperative use of AT therapy other than ASA monotherapy in elective CABG patients is linked to increased postoperative bleeding and transfusion requirements.
- The risks associated with non-ASA AT therapy are more pronounced in patients not adhering to clinical guidelines.
- These findings underscore the importance of careful selection and guideline adherence for AT therapy in patients undergoing CABG.
Objectives:
The objective of this retrospective study was to assess differences in clinical outcomes between patients on acetylsalicylic acid (ASA) monotherapy and patients on other antithrombotic (AT) regimens undergoing elective coronary artery bypass grafting (CABG).
Methods:
Patients who underwent elective isolated CABG between 2017 and 2019 at the Catharina Hospital Eindhoven were eligible for this study. The primary end points were re-exploration for bleeding and postoperative blood product transfusion. Secondary end points included 30-day mortality, in-hospital stroke, in-hospital myocardial infarction and duration of hospitalization. Propensity matching was used to compare outcomes of the main study groups (ASA vs other AT therapy) and subgroups of AT therapy (guideline adherence vs non-adherence).
Results:
A total of 1068 patients were included: 710 patients on ASA monotherapy and 358 patients on other AT regimens. In the 256 matched patients in the main study groups, using AT regimens other than ASA monotherapy was associated with increased risk of re-exploration for bleeding [6.6% vs 2.0%, P = 0.017; odds ratio (OR) 3.57 (1.29-9.83)] and increased use of blood products [37.5% vs 20.3%, P < 0.001; OR 2.35 (1.58-3.49)]. In 122 matched subgroup patients, non-adherence was associated with an increased risk of re-exploration [10.7% vs 3.3%, P = 0.044; OR 3.52 (1.11-11.12)] and increased blood product use [51.6% vs 25.4%, P < 0.001; OR 3.13 (1.83-5.38)]. Secondary end points were not significantly different among the main study groups and subgroups.
Conclusions:
Preoperative use of AT therapy other than ASA monotherapy in patients who elected CABG was associated with the increased postoperative use of blood products and risk of re-exploration for bleeding; this finding was even more pronounced in non-guideline-adherent patients.
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