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Variation in preoperative antithrombotic strategy, severe bleeding, and use of blood products in coronary artery bypass grafting : results from the multicentre E-CABG registry |
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| Author: | Biancari, Fausto1,2,3; Mariscalco, Giovanni4; Gherli, Riccardo5; |
| Organizations: |
1Heart Center, Turku University Hospital, University of Turku, PO Box 52, 20521 Turku, Finland 2Department of Surgery, University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland 3Department of Surgery, Oulu University Hospital and University of Oulu, Kajaanintie 50, PO Box 10, 90220 Oulu, Finland
4Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield, Hospital, Groby Road, Leicester, LE3 9QP Leicestershire, UK
5Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo, -Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152 Rome, Italy 6Hamburg University Heart Center, Martinistraße 52, 20251 Hamburg, Germany 7Department of Cardiovascular Surgery, Division of Cardiovascular Surgery, Verona University Hospital, P. Le Stefani 1, 37126 Verona, Italy 8Department of Cardiovascular Surgery, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany and Cittàdi Lecce Hospital GVM Care&Research, Strada Provinciale per Arnesano km 4, 73100 Lecce LE, Italy; 9Department of Cardiovascular Surgery, Centro Clinico-Diagnostico “G.B. Morgagni”, Centro Cuore, Via della Resistenza, 31, 95030 Pedara CT, Italy 10Department of Cardiovascular Surgery, St. Anna Hospital, Catanzaro, Viale Papa Pio X, 111, 88100 Catanzaro, Italy 11Division of Cardiac Surgery, University of Genoa, Largo Rosanna Benzi, 10, 16132 Genova GE, Ital 12Division of Cardiac Surgery, University of Parma, Via Gramsci 14 – 43126 Parma, Italy 13Department of Cardiac Surgery, Centro Cardiologico – Fondazione Monzino IRCCS, University of Milan, Via Carlo Parea, 4, 20138 Milan MI, Italy 14Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Rue du Général Koenig, 51100 Reims, France 15Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, 2 Rue Henri le Guilloux, 35000 Rennes, France 16Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, 3 Boulevard Alexandre Fleming, 25000 Besanc ̧on, France 17National Center of Global Health, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome RM, Italy 18Department of Cardiovascular Diseases, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 2, 80138, Naples, Italy 19Division of Cardiac Surgery, Ospedali Riuniti, via Farneto 3, 34142 Trieste, Italy 20Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Karolinska Universitetssjukhuset, Karolinska vägen, 171 76 Solna, Sweden |
| Format: | article |
| Version: | accepted version |
| Access: | open |
| Online Access: | PDF Full Text (PDF, 0.4 MB) |
| Persistent link: | http://urn.fi/urn:nbn:fi-fe2019102134013 |
| Language: | English |
| Published: |
Oxford University Press,
2018
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| Publish Date: | 2019-10-21 |
| Description: |
AbstractAims: No data exists on inter-institutional differences in terms of adherence to international guidelines regarding the discontinuation of antithrombotics and rates of severe bleeding in coronary artery bypass grafting (CABG). Methods and results: This is an analysis of 7118 patients from the prospective multicentre European CABG (E-CABG) registry who underwent isolated CABG in 15 European centres. Preoperative pause of P2Y12 receptor antagonists shorter than that suggested by the 2017 ESC guidelines (overall 11.6%) ranged from 0.7% to 24.8% between centres (adjusted P < 0.0001) and increased the rate of severe-massive bleeding [E-CABG bleeding grades 2–3, OR 1.66, 95% confidence interval (CI) 1.27–2.17; Universal Definition of Perioperative Bleeding (UDPB) bleeding grades 3–4, OR 1.50, 95% CI 1.16–1.93]. The incidence of resternotomy for bleeding (overall 2.6%) ranged from 0% to 6.9% (adjusted P < 0.0001), and surgical site bleeding (overall 59.6%) ranged from 0% to 84.6% (adjusted P = 0.003). The rate of the UDPB bleeding grades 3–4 (overall 8.4%) ranged from 3.7% to 22.3% (P < 0.0001), and of the E-CABG bleeding grades 2–3 (overall 6.5%) ranged from 0.4% to 16.4% between centres (P < 0.0001). Resternotomy for bleeding (adjusted OR 5.04, 95% CI 2.85–8.92), UDPB bleeding grades 3–4 (adjusted OR 6.61, 95% CI 4.42–9.88), and E-CABG bleeding grades 2–3 (adjusted OR 8.71, 95% CI 5.76–13.15) were associated with an increased risk of hospital/30-day mortality. Conclusions: Adherence to the current guidelines on the early discontinuation of P2Y12 receptor antagonists is of utmost importance to reduce excessive bleeding and early mortality after CABG. Inter-institutional variation should be considered for a correct interpretation of the results in multicentre studies evaluating perioperative bleeding and use of blood products. see all
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| Series: |
European heart journal. Quality of care & clinical outcomes |
| ISSN: | 2058-5225 |
| ISSN-E: | 2058-1742 |
| ISSN-L: | 2058-5225 |
| Volume: | 4 |
| Issue: | 4 |
| Pages: | 246 - 257 |
| DOI: | 10.1093/ehjqcco/qcy027 |
| OADOI: | https://oadoi.org/10.1093/ehjqcco/qcy027 |
| Type of Publication: |
A1 Journal article – refereed |
| Field of Science: |
3126 Surgery, anesthesiology, intensive care, radiology 3121 General medicine, internal medicine and other clinical medicine |
| Subjects: | |
| Copyright information: |
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal - Quality of Care and Clinical Outcomes following peer review. The version of record [insert complete citation information here] is available online at: https://doi.org/10.1093/ehjqcco/qcy027. |