title: Is continuation of antiplatelets until coronary artery bypass safe in Asians?
abstract: BACKGROUND
  Controversies have arisen about the risks of discontinuing antiplatelets prior to coronary artery bypass grafting.
  
  
  METHODS
  We retrospectively studied the effects of different strategies of antiplatelet discontinuation prior to coronary artery bypass on perioperative bleeding and major adverse cardiovascular events in Asian patients in a single center in Singapore.
  
  
  RESULTS
  402 patients were divided into 4 groups: group A had no antiplatelets before surgery; antiplatelets were stopped for 5-7 days in group B; 2-4 days in group C; and 0-1 day in group D. Compared to group B, group D had longer intensive care unit stays and more intraoperative transfusions of blood (p = 0.006) and blood products (p < 0.05). The 1-year major adverse cardiovascular event rate was higher in groups A and D (p = 0.027). Stopping antiplatelets within 24 h of surgery was one of multiple independent predictors of intraoperative transfusion but not the 1-year major adverse cardiovascular event rate. Patients on aspirin alone had less intraoperative transfusion of platelets and postoperative minor bleeding than those on combined therapy.
  
  
  CONCLUSIONS
  Continuation of antiplatelets until 2 days before coronary artery bypass in Asian patients in our institution is unlikely to increase the risks of bleeding and perioperative transfusion. Taking antiplatelets within 24 h of surgery seems to be associated with a higher rate of 1-year major adverse cardiovascular events and bleeding, and an increased risk of blood product transfusion. Thirty-day and 1-year major adverse cardiovascular event rates were higher in patients without antiplatelet treatment.
authors.affiliation: Department of Surgery, National University of Singapore, Singapore.
authors.forename: Thang Duc
authors.initials: TD
authors.lastname: Vu
authors.affiliation: Department of Surgery, National University of Singapore, Singapore.
authors.forename: Min Htet
authors.initials: MH
authors.lastname: Zaw
authors.affiliation: Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore.
authors.forename: Guohao
authors.initials: G
authors.lastname: Chang
authors.affiliation: Department of Surgery, National University of Singapore, Singapore.
authors.forename: Shu Lin Jesse
authors.initials: SL
authors.lastname: Hu
authors.affiliation: Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore.
authors.forename: Chee Wei Bobby
authors.initials: CW
authors.lastname: Tay
authors.affiliation: Department of Surgery, National University of Singapore, Singapore.
authors.forename: Celene Wei Qi
authors.initials: CW
authors.lastname: Ng
authors.affiliation: Department of Surgery, National University of Singapore, Singapore.
authors.forename: Daryl K A
authors.initials: DK
authors.lastname: Chia
authors.affiliation: Department of Surgery, National University of Singapore, Singapore Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore.
authors.forename: Chuen Neng
authors.initials: CN
authors.lastname: Lee
authors.affiliation: Department of Surgery, National University of Singapore, Singapore Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore surtk@nus.edu.sg.
authors.forename: Theo
authors.initials: T
authors.lastname: Kofidis
mesh_terms: D000368:Aged; D044466:Asian People; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Blood loss; Coronary artery bypass; Platelet aggregation inhibitors; Postoperative hemorrhage; surgical