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• W2893959565 abstract "Dual antiplatelet therapy (DAPT) reduces the incidence of major adverse ischemic events in patients with acute coronary syndrome (ACS). The surgical community often has concerns when performing urgent coronary artery bypass grafting surgery (CABG) in patients who recently received DAPT. Observational reports assessing the impact of DAPT before cardiac surgery have shown that despite the risk of bleeding, ischemic events and mortality were lower. Therefore, we aimed to evaluate the effect of preoperative exposure to DAPT versus aspirin versus no antiplatelet therapy on 30-day and one-year clinical outcomes in patients undergoing CABG. We used patient-level data from CORONARY, a randomized controlled trial of off-pump versus on-pump CABG surgical technique, for analysis. The trial included 4752 patients from 79 centers in 19 countries between 2006 and 2011. Aiming to maximize homogeneity in patient population and practice, we built a cohort with participants from North America, Europe and Australia. We divided these patients based on their pre-operative exposure to either DAPT, ASA only or no antiplatelet therapy in the seven days before surgery and assessed rates of mortality, myocardial infarction (MI), and stroke at 30 days and one year, and post-operative requirements for blood products. We conducted descriptive and logistic regression analyses adjusted for key variables including EuroSCORE, preoperative myocardial infraction, urgency, NYHA, and receiving DAPT postoperative. We included 1694 patients: 360 received DAPT, 920 received ASA and 414 received no antiplatelet agent. At one year, 71 patients had suffered an MI, 38 had a stroke and 65 had died. Mortality, MI, stroke and the composite of these three outcomes did not differ between the three groups, both at 30 days and 1 year. Exposure to DAPT was associated with significantly higher rates of red blood cell, plasma and platelet transfusion rates when compared to no antiplatelet or ASA alone (table 1). However, chest tube output at 12 hours and re-exploration after CABG did not differ significantly across the 3 groups (table 1). Patients on DAPT in the seven days before CABG surgery received significantly more blood products with a trend for higher re-exploration rate; however, clinical outcomes at 30 days and 1 year did not differ significantly from patients on ASA only or no antiplatelet agent." @default.
• W2893959565 created "2018-10-05" @default.
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• W2893959565 date "2018-10-01" @default.
• W2893959565 modified "2023-10-16" @default.
• W2893959565 title "IMPACT OF ANTIPLATELET THERAPY MANAGEMENT ON CLINICAL AND BLEEDING OUTCOMES IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT SURGERY: A CORONARY TRIAL SUBSTUDY" @default.
• W2893959565 doi "https://doi.org/10.1016/j.cjca.2018.07.291" @default.
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