Abstract 20476: Ticagrelor : Similar Rates of Perioperative Hemorrhagic Complications and Mid-Term Survival Compared With Clopidogrel
Introduction: The PLATO trial suggested that ticagrelor is associated with better survival at 1 year for patients with acute coronary syndrome (ACS) undergoing coronary artery bypass grafting (CABG). The aim of this study was to compare perioperative bleeding complications and mid-term outcomes of patients receiving ticagrelor or clopidogrel perioperatively over a 2 years period in our institution.
Hypothesis: We assessed the hypothesis that perioperative use of ticagrelor would result in better clinical outcomes without increasing bleeding risks in ACS patients undergoing CABG.
Methods: Data were recorded from 467 patient’s file who underwent CABG following an ACS between 2013 and 2015. The Bleeding Academic Research Consortium (BARC) and Thrombolysis in Myocardial Infarction (TIMI) criteria were used to assess major bleedings.
Results: Ticagrelor was stopped 4.5±0.50 days prior to surgery (5.8±0.29 days for clopidogrel ; p=0.06). BARC (6.2% vs 8.5% ; p=0.46) and TIMI (5.2% vs 7.3% ; p=0.43) major bleedings were similar. Among major bleedings, 24 occurred when discontinuation time was ≤3 days prior to surgery (17 vs 7 ; p=0.43) and 6 at >3 days (6 vs 0 ; p=0.34), for clopidogrel and ticagrelor respectively. Multivariate analyses showed that independent predictors of perioperative bleeding were immediate preoperative aPTT; shorter delay between antiplatelet discontinuation and surgery, preoperative haemoglobin and CPB duration. The type of antiplatelet agent used was not a significant factor. One year follow up showed no difference in survival (99.1%, vs 95.5% ; p=0.25), death from cardiovascular causes (1.6% vs 1.2% ; p=1.0), angina stability (50.5±6.2 vs 51.1±7.3 ; p=0.58) and frequency (97.8±8.4 vs 98.1±7.4 ; p=0.84) according to the Seattle Angina score for clopidogrel and ticagrelor, respectively.
Conclusion: The use of ticagrelor is not associated with a higher risk of perioperative hemorrhagic complications when compared with clopidogrel. Mortality rates from cardiovascular causes were lower than expected from the PLATO study. Prospective studies are needed to assess ideal discontinuation time for ticagrelor and determine the long term clinical outcomes of CABG patients receiving ticagrelor perioperatively.
Author Disclosures: V. Chauvette: None. É. Voisine: None. A. Moisan: None. S. Mohammadi: None. F. Dagenais: None. P. Voisine: None.
- © 2016 by American Heart Association, Inc.