Early clinical outcomes of surgical myocardial revascularization in patients with preoperative platelet dysfunction

Abstract

Background/Aim. Coronary artery bypass grafting (CABG) is the treatment of choice for significant number of the patients with ischemic heart disease. Some of the postoperative complications are closely linked with the preoperative antiplatelet therapy (APT). The aim of this study was to compare the early clinical outcomes of CABG in patients with preserved platelet (PLT) function and patients with platelet function impaired by the residual therapeutic effect of APT. Methods. A total of 181 patients with isolated CABG were enrolled in this prospective, nonrandomized, observational study. Subjects were divided in four groups: Control (arachidonic acid-dependent PLT aggregation - ASPI) ? 790 AU/min, adenosine diphosphate (ADP) ? 406 AU/min, Mild acetylsalicylic acid - ASA (ASPI 410-789 AU/min), Pronounced ASA (ASPI ? 409 AU/min) and dual APT (DAPT) (ASPI ? 789 AU/min; ADP ? 405 AU/min). Preoperative data, intraoperative characteristics and postoperative outcomes were obtained and compared between groups. Results. A significant difference was found regarding the average time of APT cessation between groups (p < 0.001). DAPT group had significantly higher drainage compared to Control group (p = 0.004), Mild ASA group (p = 0.001) and compared to Pronounced ASA group (p = 0.006). Pronounced ASA group had significantly higher rate of chest reexploration compared to Mild ASA group (p = 0.032). DAPT group required significantly more packed red blood cells (PRBC) compared to Control group (p < 0.001) and Mild ASA group (p = 0.009). Pronounced ASA group received significantly more PRBC compared to Control group (p < 0.001) and Mild ASA group (p = 0.019). DAPT group required higher amounts of PLT compared to Control group (p < 0.001), Mild ASA group (p = 0.002) and Pronounced ASA group (p < 0.001). DAPT group received higher amounts of cryoprecipitate compared to Control group (p = 0.002), Mild ASA group (p = 0.009) and Pronounced ASA group (p = 0.016). Conclusion. Patients with a residual effect of DAPT as well as patients with a pronounced residual effect of ASA have a higher risk of postoperative bleeding and chest reexploration, and increased transfusions demands.