Variation in preoperative antithrombotic strategy, severe bleeding, and use of blood products in coronary artery bypass grafting: results from the multicentre E-CABG registry

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 RosatoPaola D'Errigo, Vito D'Andrea, Marisa De Feo, Tuomas Tauriainen, Giuseppe Gatti, Magnus Dalén

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)246-257
Number of pages12
JournalEuropean heart journal. Quality of care & clinical outcomes
Volume4
Issue number4
DOIs
Publication statusPublished - Oct 1 2018

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Keywords

  • Aged
  • Blood Loss, Surgical/prevention & control
  • Blood Transfusion/standards
  • Coronary Artery Bypass
  • Coronary Artery Disease/surgery
  • Europe/epidemiology
  • Female
  • Fibrinolytic Agents/adverse effects
  • Humans
  • Incidence
  • Male
  • Practice Guidelines as Topic
  • Preoperative Care/standards
  • Prospective Studies
  • Thrombolytic Therapy/adverse effects

Cite this

Biancari, F., Mariscalco, G., Gherli, R., Reichart, D., Onorati, F., Faggian, G., Franzese, I., Santarpino, G., Fischlein, T., Rubino, A. S., Maselli, D., Nardella, S., Salsano, A., Nicolini, F., Zanobini, M., Saccocci, M., Ruggieri, V. G., Bounader, K., Perrotti, A., ... Dalén, M. (2018). 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 & clinical outcomes, 4(4), 246-257. https://doi.org/10.1093/ehjqcco/qcy027