Impact of Preoperative Platelet ADP/P2Y12 Receptor Antagonist Management in Patients Undergoing Elective Isolated Coronary Artery Bypass Grafting

Background: Postoperative bleeding remains an important issue in patients undergoing coronary artery bypass grafting (CABG), being associated with blood product transfusions (BPT) and re-exploration. Since 2020, We have implemented a strict preoperative antithrombotic, specifically platelet ADP/P2Y12 receptor antagonist, management based on the results of a previous study of our institution. The objective of the present study was to assess its impact on clinical outcomes. Methods: Patients who underwent elective isolated CABG between 2017 and 2022 at the Catharina Hospital Eindhoven were included and divided into two groups, based on whether they were treated according to the modified antithrombotic management. The primary endpoints were perioperative BPT and re-exploration for bleeding. Secondary endpoints included length of hospital stay, in-hospital stroke, myocardial infarction (MI) and 30-day mortality. Propensity score matching was performed to compare outcomes of both cohorts. Results: A total of 1506 patients were included, of which 1064 belonged to the first historical cohort. The remaining 442 patients (second cohort) were treated according to the modified management. In the 439 matched pairs, the implementation of the strict protocol was associated with a reduced incidence of blood product transfusions (14.8% vs. 24.1%, p = 0.001) and a shorter length of hospital stay (5 [interquartile range (IQR) 4–6] days vs. 6 [IQR 5–7.5] days, p < 0.001), whereas the incidence of postoperative MI and stroke did not differ. Re-exploration for bleeding was less frequently observed in the second cohort (1.4% vs. 3.6%, p = 0.052). Conclusions: The implementation of the modified strict preoperative ADP/P2Y12 antagonist management resulted in decreased incidence of blood product transfusions, shorter hospital stay and a clinically relevant decreased rate of re-exploration for bleeding.