• Thang Duc Vu, Min Htet Zaw, Guohao Chang, Shu Lin Jesse Hu, Chee Wei Bobby Tay, Celene Wei Qi Ng, Chia Daryl K A DK Department of Surgery, National University of Singapore, Singapore., Chuen Neng Lee, and Theo Kofidis.
• Department of Surgery, National University of Singapore, Singapore.
• Asian Cardiovasc Thorac Ann. 2014 Oct 1; 22 (8): 909-18.

BackgroundControversies have arisen about the risks of discontinuing antiplatelets prior to coronary artery bypass grafting.MethodsWe retrospectively studied the effects of different strategies of antiplatelet discontinuation prior to coronary artery bypass on perioperative bleeding and major adverse cardiovascular events in Asian patients in a single center in Singapore.Results402 patients were divided into 4 groups: group A had no antiplatelets before surgery; antiplatelets were stopped for 5-7 days in group B; 2-4 days in group C; and 0-1 day in group D. Compared to group B, group D had longer intensive care unit stays and more intraoperative transfusions of blood (p = 0.006) and blood products (p < 0.05). The 1-year major adverse cardiovascular event rate was higher in groups A and D (p = 0.027). Stopping antiplatelets within 24 h of surgery was one of multiple independent predictors of intraoperative transfusion but not the 1-year major adverse cardiovascular event rate. Patients on aspirin alone had less intraoperative transfusion of platelets and postoperative minor bleeding than those on combined therapy.ConclusionContinuation of antiplatelets until 2 days before coronary artery bypass in Asian patients in our institution is unlikely to increase the risks of bleeding and perioperative transfusion. Taking antiplatelets within 24 h of surgery seems to be associated with a higher rate of 1-year major adverse cardiovascular events and bleeding, and an increased risk of blood product transfusion. Thirty-day and 1-year major adverse cardiovascular event rates were higher in patients without antiplatelet treatment.© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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