Ticagrelor does not Increase Postoperative Complications Regarding Bleeding and the Need for Transfusions Compared to Clopidogrel or Aspirin in Off-pump Coronary Artery Bypass Surgery

Objective: We hypothesized that patients treated with ticagrelor compared with those treated with clopidogrel or aspirin before off-pump coronary artery bypass surgery (OPCAB) are at increased risk of hemorrhagic complications needing transfusions and are more likely to need surgical reexploration.

Method: Preoperative and postoperative clinical data were collected prospectively of 548 consecutive patients treated preoperatively with ticagrelor and aspirin (group T, n = 34), clopidogrel and aspirin (group C, n = 127) or only aspirin (group A, n = 387) before undergoing isolated OPCAB at our institution from 2010 to 2016.

Results: Patient demographics showed no significant differences among patient groups, however more patients in the ticagrelor and the clopidogrel group underwent urgent/emergent OPCAB compared with those under aspirin treatment, 20% vs 16% vs 4% (p < 0.001). Chest tube drainage showed no significant differences among patient groups 12 hours after OPCAB, 416ml (group T) vs 491.7ml (group C) vs 453.9ml (group A), and a slight increase in chest tube drainage 24 hours after surgery in those with clopidogrel compared with those with ticagrelor, 778.1ml (group C) vs 622.1ml (group T, p = 0.02), but not compared with aspirin 720.8 ml (group A).The number of transfusions of red blood cells, platelets and fresh-frozen plasma were significantly higher in the clopidogrel compared with the aspirin group (p = 0.01), but there was no significant difference in those with ticagrelor and aspirin only. No patient needed surgical reexploration for bleeding complications among all three groups. In-hospital mortality was 0% (group T), 2.3% (group C) and 0.8% (group A).

Conclusion: Pretreatment with ticagrelor, compared with clopidogrel or aspirin, in patients undergoing OPCAB does not increase postoperative bleeding complications and the need for platelet transfusions. Therefore, pretreatment with ticagrelor should not be a reason to delay OPCAB surgery.

No conflict of interest has been declared by the author(s).