title: Impact of preoperative dual antiplatelet therapy on bleeding complications in patients with acute coronary syndromes who undergo urgent coronary artery bypass grafting.
abstract: A 5- to 7-day washout period before coronary artery bypass grafting (CABG) is recommended for patients who have recently received a thienopyridine derivative; however, data supporting this guideline recommendation are lacking in Japanese patients.
  
  
  
  Urgent isolated CABG was performed in 130 consecutive patients with acute coronary syndromes (ACS) (101 men; mean age, 69 years). Urgent CABG was defined as operation performed within 5 days after coronary angiography. All patients continued to receive aspirin 100mg/day. The subjects were retrospectively divided into 2 groups: 30 patients with preoperative thienopyridine (clopidogrel in 15 patients, ticlopidine in 15) exposure within 5 days [dual antiplatelet therapy (DAPT) group] and 100 patients without exposure [single antiplatelet therapy (SAPT) group].
  
  
  
  Although the DAPT group had a higher proportion of patients who received perioperative platelet transfusions than the SAPT group (50% vs. 18%, p<0.001), intraoperative bleeding (median, 1100ml; interquartile range, 620-1440 vs. 920ml; 500-1100) and total drain output within 48h after surgery (577±262 vs. 543±277ml) were similar. CABG-related major bleeding, which was defined as type 4 or 5 bleeding according to the Bleeding Academic Research Consortium definitions, occurred in a significantly higher proportion of patients in the DAPT group than in the SAPT group (20% vs. 3%, p=0.005). This difference in major bleeding was driven mainly by the higher rate of transfusion of ≥5U red blood cells within a 48-h period in the DAPT group (13% vs. 1%, p=0.01). There was no significant difference in the 30-day composite endpoint including death, myocardial (re)infarction, ischemic stroke, and refractory angina between the DAPT group and SAPT group (17% vs. 19%).
  
  
  
  Preoperative DAPT increases the risk of CABG-related major bleeding in Japanese patients with ACS undergoing urgent CABG.
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Zenko
authors.initials: Z
authors.lastname: Nagashima
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. Electronic address: k-tsuka@yokohama-cu.ac.jp.
authors.forename: Kengo
authors.initials: K
authors.lastname: Tsukahara
authors.affiliation: Cardiovascular Surgery, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Uchida
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hibi
authors.affiliation: Cardiovascular Surgery, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Karube
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ebina
authors.affiliation: Cardiovascular Surgery, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Imoto
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D001803:Blood Transfusion / Q000706:statistics & numerical data; D000077144:Clopidogrel; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D004630:Emergencies; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011725:Pyridines / Q000008:administration & dosage; D012189:Retrospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Bleeding; Coronary artery bypass grafting; Coronary heart disease; Platelet inhibitors