title: Transfusion outcomes in patients undergoing coronary artery bypass grafting treated with prasugrel or clopidogrel: TRITON-TIMI 38 retrospective data analysis.
abstract: OBJECTIVE
  Coronary artery bypass grafting-related bleeding and associated transfusion is a concern with dual antiplatelet therapy in patients with acute coronary syndromes. The objective of the present study was to characterize a potential risk-adjusted difference in transfusion requirements between prasugrel and clopidogrel cohorts.
  
  
  METHODS
  The data from 422 patients undergoing isolated coronary artery bypass grafting from the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel Thrombolysis In Myocardial Infarction 38 were analyzed retrospectively.
  
  
  RESULTS
  We found no difference in baseline transfusion risk scores between cohorts. As predicted, the number of units of red blood cells transfused perioperatively correlated with the transfusion risk score (P < .0001). Overall, the 12-hour chest tube drainage volumes and platelet transfusion rates in the prasugrel cohort were significantly greater. However, no statistically significant differences were found in the number of red blood cell transfusions, total hemostatic components transfused, or total blood donor exposure. A significantly greater number of platelet units were transfused postoperatively in the prasugrel patients who underwent surgery within 5 days or less after withdrawal of drug. In an analysis adjusted for the predicted risk of mortality, total donor exposure was not associated with increased mortality.
  
  
  CONCLUSIONS
  The use of prasugrel compared with clopidogrel was associated with greater 12-hour chest tube drainage volumes and platelet transfusion rates but without any significant differences in red blood cell transfusions, total hemostatic components transfused, or total blood donor exposure.
authors.affiliation: Departments of Pathology and Medicine, Stanford University School of Medicine, Stanford, Calif. Electronic address: Ltgoodno@stanford.edu.
authors.forename: Lawrence T
authors.initials: LT
authors.lastname: Goodnough
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Smith
authors.affiliation: Department of Anesthesiology, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Jerrold H
authors.initials: JH
authors.lastname: Levy
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona School of Medicine, Tucson, Ariz.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Poston
authors.affiliation: Lilly USA, LLC, Indianapolis, Ind.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Short
authors.affiliation: Lilly USA, LLC, Indianapolis, Ind.
authors.forename: Govinda J
authors.initials: GJ
authors.lastname: Weerakkody
authors.affiliation: Lilly USA, LLC, Indianapolis, Ind.
authors.forename: LeRoy A
authors.initials: LA
authors.lastname: LeNarz
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D006801:Humans; D010879:Piperazines / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017713:Platelet Transfusion; D000068799:Prasugrel Hydrochloride; D012189:Retrospective Studies; D012307:Risk Factors; D013876:Thiophenes / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine