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Published on: March 15, 2022
Different antithrombotic strategies after coronary artery bypass grafting to prevent adverse events: a retrospective
Yi Shi1, Shenglong Chen1, Gang Liu1
1Department of Cardiac Surgery, Peking University People's Hospital, Peking University Health and Science Center, Xizhimen St, Beijing, 100044, China.
Insights
Early dual antiplatelet therapy (DAPT) after coronary artery bypass grafting (CABG) is safe, with no increased bleeding risk. However, combining anticoagulants with antiplatelet therapy raises bleeding concerns in CABG patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Coronary artery bypass grafting (CABG) frequently involves antithrombotic therapy.
- The safety and efficacy of early antithrombotic use post-CABG remain under investigation.
Purpose of the Study:
- To evaluate the association between postoperative antithrombotic strategies and in-hospital adverse events.
- To compare bleeding and adverse event risks in patients undergoing isolated CABG.
Main Methods:
- Retrospective cohort analysis of 3274 patients undergoing isolated CABG (2001-2012).
- Patients were grouped into aspirin alone (ASA) or dual antiplatelet therapy (DAPT: aspirin plus clopidogrel).
- Propensity score matching (PSM) was used to control for confounding factors.
Main Results:
- No significant difference in major bleeding risk was observed between ASA and DAPT groups post-PSM.
- Postoperative mortality did not differ between the groups.
- Anticoagulant therapy, particularly early heparin use, independently predicted increased bleeding-related events.
Conclusions:
- Dual antiplatelet therapy (DAPT) is a safe antiplatelet strategy post-CABG, not linked to increased bleeding.
- Concurrent anticoagulant and antiplatelet therapy increases bleeding risk and warrants cautious clinical application.
Objective:
Coronary artery bypass grafting (CABG) is associated with antithrombotic therapy in terms of postoperative adverse events; however, it is still unknown whether the early use of such drugs after CABG is safe and effective. In this study, we aim to evaluate the relationship between different postoperative antithrombotic strategies and in-hospital adverse events in patients undergoing isolated coronary artery bypass grafting surgery.
Methods:
This was a single-center, retrospective cohort analysis of patients undergoing isolated CABG due to coronary artery disease (CAD) between 2001 and 2012. Data were extracted from the Medical Information Mart for Intensive Care III database. The patients involved were divided into the ASA (aspirin 81 mg per day only) or DAPT (aspirin plus clopidogrel 75 mg per day) group according to the antiplatelet strategy. Patients were also stratified into subgroups based on the type of anticoagulation. The in-hospital risk of bleeding and adverse events was investigated and compared between groups. Propensity score matching (PSM) was performed to reduce the potential effects of a selection bias.
Results:
A total of 3274 patients were included in this study, with 2358 in the ASA group and 889 in the DAPT group. Following the PSM, no significant difference was seen in the risk of major bleeding between the two groups according to the PLATO, TIMI or GUSTO criteria. There was no difference in the postoperative mortality. In subgroup analysis, patients given anticoagulant therapy had an increased incidence of bleeding-related events. Multivariable analysis revealed that postoperative anticoagulant therapy and the early use of heparin, but not DAPT, were independent predictors of bleeding-related events.
Conclusions:
Postoperative DAPT was not associated with an increased occurrence of bleeding-related events in patients undergoing isolated CABG and appears to be a safe antiplatelet therapy. The addition of anticoagulants to antiplatelet therapy increased the risk of bleeding and should be considered cautiously in clinical practice.
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