Use of adenosine diphosphate receptor inhibitor prior to left ventricular assist device implantation is not associated with increased bleeding.
Current guidelines recommend adenosine diphosphate receptor inhibitors (ADPRi) be discontinued 5-7 days prior to cardiac surgery due to increased bleeding events, rates of re-exploration, and transfusions. However, the risks of left ventricular assist device (LVAD) implantation in patients taking an ADPRi have not previously been studied. We retrospectively identified 134 eligible patients with ischemic cardiomyopathy that underwent LVAD implantation between July 2009 and August 2013. The cohorts received an ADPRi ≤5 days of surgery (n = 25) versus >5 days prior or not at all (n = 109). Subgroup analyses adjusted for differences in frequency of redo sternotomy between cohorts, excluded patients that received an ADPRi >1 year prior to surgery, and excluded patients with a redo sternotomy. The ADPRi and control groups did not have significant differences in the primary outcomes, intraoperative PRBC units transfused (3.0 vs. 4.0, p = 0.12) or chest tube output within 24 h of surgery (1.66 L vs. 1.80 L, p = 0.61). After adjusting for differences in frequency of redo sternotomy (ADPRi vs. control, 12 vs. 52%, p ≤ 0.001), no significant difference in PRBC units transfused (3.1 vs. 3.5, p = 0.59) or chest tube output (2.04 L vs. 2.04 L, p = 0.98) was seen. No significant difference in 30-day mortality (8.0 vs. 11.0%, p = 0.63), 90-day mortality (16.4 vs. 23.3%, p = 0.42), or length of stay (29.0 vs. 28.0, p = 0.61) was seen. In this single-center experience, use of an ADPRi ≤5 days prior to LVAD implantation was not associated with increased bleeding, length of stay, or mortality.
Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Anjan
A
Tibrewala
Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA.
Michael E
ME
Nassif
Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Adam
A
Andruska
Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA.
Jerrica E
JE
Shuster
Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA.
Eric
E
Novak
Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA.
Justin M
JM
Vader
Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA.
Gregory A
GA
Ewald
Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA.
Shane J
SJ
LaRue
Division of Cardiothoracic Surgery, Washington University School of Medicine, Campus Box 8234, 660 S Euclid Avenue, St. Louis, MO, 63110, USA.
Scott
S
Silvestry
Division of Cardiothoracic Surgery, Washington University School of Medicine, Campus Box 8234, 660 S Euclid Avenue, St. Louis, MO, 63110, USA. itoha@wudosis.wustl.edu.
Akinobu
A
Itoh
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D056346:Sternotomy; D016896:Treatment Outcome; D028761:Withholding Treatment
D058921:Purinergic P2Y Receptor Antagonists
Adenosine diphosphate receptor inhibitor; Bleeding; Clopidogrel; Left ventricular assist device; P2Y12 inhibitor