University of Oulu

Fausto Biancari, Giovanni Mariscalco, Riccardo Gherli, Daniel Reichart, Francesco Onorati, Giuseppe Faggian, Ilaria Franzese, Giuseppe Santarpino, Theodor Fischlein, Antonino S Rubino, Daniele Maselli, Saverio Nardella, Antonio Salsano, Francesco Nicolini, Marco Zanobini, Matteo Saccocci, Vito G Ruggieri, Karl Bounader, Andrea Perrotti, Stefano Rosato, Paola D’Errigo, Vito D’Andrea, Marisa De Feo, Tuomas Tauriainen, Giuseppe Gatti, Magnus Dalén, Variation in preoperative antithrombotic strategy, severe bleeding, and use of blood products in coronary artery bypass grafting: results from the multicentre E-CABG registry, European Heart Journal - Quality of Care and Clinical Outcomes, Volume 4, Issue 4, October 2018, Pages 246–257,

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)
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Language: English
Published: Oxford University Press, 2018
Publish Date: 2019-10-21


Aims: 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.

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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
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
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: