Bleeding complications after dual antiplatelet therapy with ticagrelor versus dual antiplatelet therapy with clopidogrel
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ORIGINAL ARTICLE
Bleeding complications after dual antiplatelet therapy with ticagrelor versus dual antiplatelet therapy with clopidogrel— a propensity-matched comparative study of two antiplatelet regimes in off-pump coronary artery bypass grafting Praveen Kerala Varma 1 & Hisham Ahmed 2 & Neethu Krishna 1 & Rajesh Jose 1 & Kirun Gopal 1 & Oommen Plavannal Mathew 3 & Aveek Jayant 4 Received: 25 February 2020 / Revised: 30 August 2020 / Accepted: 7 September 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Purpose Ticagrelor combined with aspirin had shown better saphenous vein graft patency than aspirin with clopidogrel after offpump coronary artery bypass grafting. However, the safety of this drug in regard to bleeding complications remains unknown. The aim of our study was to assess the bleeding complications of dual antiplatelet therapy with aspirin and ticagrelor compared with aspirin and clopidogrel within the first 3 months after off-pump surgery. Methods Three hundred eighty-two consecutive patients who were prescribed aspirin with ticagrelor (ticagrelor group) were compared with 660 patients who received aspirin and clopidogrel (clopidogrel group). After propensity matching, 144 patients in each group were compared for bleeding events and major adverse cardiac and cerebral events. Major bleeding was defined as composite outcome of re-exploration for bleeding, any fatal bleeding, intracranial bleeding, and any bleeding requiring hospitalization. Results Patients in the ticagrelor group had more incidence of re-exploration for bleeding (p = 0.042), pericardial effusion requiring drainage (p = 0.007), readmissions (p < 0.01), gastrointestinal bleeding (p = 0.01), and major bleeding (5.8% vs. 2.1%, p < 0.01, OR 2.8 (1.43–5.58)). After propensity analysis, gastrointestinal bleed (p = 0.024), major bleeding (7.6% vs.1.4%, p < 0.001, OR 5.8 (1.28–26.97)), length of ICU stay (p = 0.039), and readmissions (p = 0.003, OR 11.83 (1.51– 92.86)) were more in the ticagrelor group. Major adverse cardiac and cerebral events were similar between the groups. Conclusion Dual antiplatelet therapy with aspirin and ticagrelor increased gastrointestinal bleeding events, major bleeding events, and readmission rates compared with aspirin and clopidogrel after off-pump coronary artery bypass grafting. Keywords Dual antiplatelet therapy . Bleeding . Ticagrelor . Clopidogrel . Off-pump CABG . CABG . OPCAB
Introduction
* Praveen Kerala Varma [email protected] 1
Department of Cardiothoracic Surgery, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham (Amrita University), Kochi, India
2
Department of Cardiology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham (Amrita University), Kochi, India
3
Population Research Center, University of Kerala, Trivandrum, India
4
Department of Anesthesiology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham (Amrita University), Kochi, India
Dual antiplatelet therapy (DAPT) refers to the use of aspirin with P2Y12 receptor an
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