Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Schoerghuber, M; Kuenzer, T; Biancari, F; Dalén, M; Hansson, EC; Jeppsson, A; Schlachtenberger, G; Siegemund, M; Voetsch, A; Pregartner, G; Lindenau, I; Zimpfer, D; Berghold, A; Mahla, E; Zirlik, A.
Platelet inhibitor withdrawal and outcomes after coronary artery surgery: an individual patient data meta-analysis.
Eur J Cardiothorac Surg. 2024;
Doi: 10.1093/ejcts/ezae265
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- Führende Autor*innen der Med Uni Graz
- Berghold Andrea
- Schörghuber Michael
- Co-Autor*innen der Med Uni Graz
- Kuenzer Thomas
- Lindenau Ines
- Mahla Elisabeth
- Pregartner Gudrun
- Vötsch Andreas
- Zimpfer Daniel
- Zirlik Andreas
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- Abstract:
- OBJECTIVE: To evaluate the association between guideline-conforming as compared to shorter than recommended withdrawal period of P2Y12 receptor inhibitors prior to isolated on-pump coronary artery bypass grafting (CABG) and the incidence of severe bleeding and ischemic events. Randomized controlled trials are lacking in this field. METHODS: We searched PUBMED, Embase and other suitable databases for studies including patients on P2Y12 receptor inhibitors undergoing isolated CABG and reporting bleeding and postoperative ischemic events from 2013 to March 2024. The primary outcome was incidence of Bleeding Academic Research Consortium type 4 (BARC-4) bleeding defined as any of the following: perioperative intracranial bleeding, reoperation for bleeding, transfusion of ≥ 5 units of red blood cells, chest tube output of ≥ 2 liters. The secondary outcome were postoperative ischemic events according to the Academic Research Consortium 2 Consensus Document. Patient-level data provided by each observational trial were synthesized into a single dataset and analyzed using a two-stage IPD-MA. RESULTS: Individual data of 4,837 patients from 7 observational studies were synthesized. BARC-4 bleeding, 30-day mortality, and postoperative ischemic events occurred in 20%, 2.6%, and 5.2% of patients. After adjusting for EuroSCORE II and cardiopulmonary bypass time, guideline-conforming withdrawal was associated with decreased BARC-4 bleeding risk in patients on clopidogrel (adjusted odds ratio [OR] 0.48, 95% confidence intervals (CI) 0.28-0.81, P = 0.006) and a trend toward decreased risk in patients on ticagrelor (adjusted OR 0.48, 95% CI 0.22-1.05; P = 0.067). Guideline-conforming withdrawal was not significantly associated with 30-day mortality risk (clopidogrel: adjusted OR 0.70, 95% CI 0.30-1.61; ticagrelor: adjusted OR 0.89, 95% CI 0.37-2.18) but with decreased risk of postoperative ischemic events in patients on clopidogrel (clopidogrel: adjusted OR 0.50, 95% CI 0.30-0.82; ticagrelor: adjusted OR 0.78, 95% CI 0.45 -1.37). BARC-4 bleeding was associated with 30-day mortality risk (adjusted OR 4.76, 95% CI 2.67-8.47; P < 0.001). CONCLUSIONS: Guideline-conforming preoperative withdrawal of ticagrelor and clopidogrel was associated with a 50% reduced BARC-4 bleeding risk when corrected for EuroSCORE II and cardiopulmonary bypass time but was not associated with increased risk of 30-day mortality or postoperative ischemic events.
- Find related publications in this database (Keywords)
- P2Y(12) receptor inhibitors
- Coronary artery bypass grafting
- Cardiopulmonary bypass
- BARC-4 bleeding
- Mortality
- Postoperative ischaemic events