Specific risk for bleeding with CABG

Specific risk for bleeding with CABG

Specific risk for bleeding with CABG: Coronary artery bypass grafting (CABG) surgery has a few specific factors to it which can cause bleeding:

1. Whole body heparinization therapy
2. Platelet dysfunction due to cardiopulmonary bypass pump
3. Altered fibrinolysis

Even though the recommendation is to stop antiplatelet agents 5 days prior to surgery (7 days in case of prasugrel), sometimes surgery may have to be done on an emergency basis. This enhances the chance of perioperative bleeding.

A study evaluated the bleeding risk with ticagrelor and clopidogrel [1]. They found that bleeding risk was high if the medications were discontinued less than 24 hours prior to surgery, as occurs in an emergency surgery. Discontinuation 3 days prior to surgery vs 5 days prior to surgery did not increase the risk of bleeding with ticagrelor. But shorter period of discontinuation increased the bleeding risk with clopidogrel. Overall, risk of major bleeding related to CABG was lower with ticagrelor than clopidogrel.

Reference

1. Emma C Hansson, Lena Jidéus, Bengt Åberg Henrik Bjursten, Mats Dreifaldt, Anders Holmgren, Torbjörn Ivert, Shahab Nozohoor, Mikael Barbu, Rolf Svedjeholm, Anders Jeppsson. Coronary Artery Bypass Grafting-Related Bleeding Complications in Patients Treated With Ticagrelor or Clopidogrel: A Nationwide Study. Eur Heart J. 2016 Jan 7;37(2):189-97.