Preoperative treatment with clopidogrel and ticagrelor on bleeding complications in off-pump coronary artery bypass grafting

Wang, Zi; Li, Xiaoye; Ye, Yanrong; Xia, Limin; Zou, Ye; Xu, Qing; Yao, Yao; Li, Xiaoyü; Lv, Qianzhou

doi:10.1016/j.thromres.2022.09.010

Cited by 1 publication

(1 citation statement)

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“…For example, in a previous study, researchers found that the overall risk of major CABG-related bleeding complications was lower with ticagrelor than with clopidogrel and the difference was driven by a lower incidence with ticagrelor than with clopidogrel when the platelet inhibitor was discontinued 72–120 h before surgery 47 . However, our previous study showed that in the setting of OPCABG, there were no significant differences in severe perioperative bleeding between clopidogrel and ticagrelor groups 48 . Based on the findings of the current study, the multivariable analysis showed that the genetic factor, that is, the ABCB1 3435 CC genotype, may be another potential factor related to perioperative bleeding, consistent with the findings in our previous analysis 49 .…”

Section: Discussionmentioning

confidence: 89%

Clinical efficacy of clopidogrel and ticagrelor in patients undergoing off-pump coronary artery bypass grafting: a retrospective cohort study

Wang,

Ma,

et al. 2024

International Journal of Surgery

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Background: Ticagrelor is reportedly more effective than clopidogrel in preventing atherothrombotic events in patients with percutaneous coronary intervention. However, the optimal antiplatelet therapy strategy after off-pump coronary artery bypass grafting (OPCABG) is yet to be established. Materials and Methods: This study was performed using the prospectively-maintained database at our institution. Patients who underwent OPCABG were divided into the clopidogrel and the ticagrelor groups. Propensity score matching analysis was performed between the two groups. The clinical outcome was the occurrence of major adverse cardiovascular event (MACE), defined as a composite of vascular death, myocardial infarction, or stroke 1 year after surgery. Results: In total, 545 patients completed the entire follow-up assessment. After propensity score matching, 232 patients each were included in the clopidogrel and ticagrelor groups. The primary outcome occurred in 7.8% and 4.3% of patients in the clopidogrel and ticagrelor groups, respectively (P=0.113). CYP2C19 variants (*2, *3, and *17) did not impact the clinical outcomes, regardless of the use of clopidogrel or ticagrelor. The rates of MACE were significantly lower in patients carrying the ABCB1 C3435T CT/TT genotypes in the ticagrelor group than in those carrying the ABCB1 C3435T CC genotype in the clopidogrel group (1.4% vs. 9.1%, adjusted P=0.030), as well as those carrying the ABCB1 C3435T CC genotype in the ticagrelor group (1.4% vs. 8.9%, adjusted P=0.036). The ABCB1 C3435T CC genotype was significantly associated with the incidence of 1-year MACE (HR=1.558, 95% CI 1.109–2.188, P=0.011). Patients who experienced severe perioperative bleeding exhibited a significantly higher incidence of MACE than those who did not experience severe perioperative bleeding (14.0% vs. 4.9%, adjusted P=0.007). Conclusion: There was no significant difference in the 1-year MACE between patients receiving clopidogrel and those receiving ticagrelor after OPCABG. Notably, The ABCB1 C3435T CC genotype was related to a higher risk of MACE.

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Section: Discussionmentioning

confidence: 89%