Perioperative bleeding in patients with acute coronary syndrome treated with fondaparinux versus low-molecular-weight heparin before coronary artery bypass grafting
Khodabandeh, Sorosh; Biancari, Fausto; Kinnunen, Eeva-Maija; Mariscalco, Giovanni; Airaksinen, Juhani; Gherli, Riccardo; Gatti, Giuseppe; Demal, Till; Onorati, Francesco; Faggian, Giuseppe; De Feo, Marisa; Santarpino, Giuseppe; Rubino, Antonino S.; Maselli, Daniele; Salsano, Antonio; Nicolini, Francesco; Zanobini, Marco; Ruggieri, Vito G.; Bounader, Karl; Perrotti, Andrea; Dalén, Magnus (2018-11-24)
Sorosh Khodabandeh, Fausto Biancari, Eeva-Maija Kinnunen, Giovanni Mariscalco, Juhani Airaksinen, Riccardo Gherli, Giuseppe Gatti, Till Demal, Francesco Onorati, Giuseppe Faggian, Marisa De Feo, Giuseppe Santarpino, Antonino S. Rubino, Daniele Maselli, Antonio Salsano, Francesco Nicolini, Marco Zanobini, Vito G. Ruggieri, Karl Bounader, Andrea Perrotti, Magnus Dalén, Perioperative Bleeding in Patients With Acute Coronary Syndrome Treated With Fondaparinux Versus Low-Molecular-Weight Heparin Before Coronary Artery Bypass Grafting, The American Journal of Cardiology, Volume 123, Issue 4, 2019, Pages 565-570, ISSN 0002-9149, https://doi.org/10.1016/j.amjcard.2018.11.028
© 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
https://creativecommons.org/licenses/by-nc-nd/4.0/
https://urn.fi/URN:NBN:fi-fe201901242933
Tiivistelmä
Abstract
The perioperative bleeding risk in patients receiving fondaparinux versus low-molecular weight heparin before coronary artery bypass grafting has not been reported. We evaluated perioperative coronary artery bypass grafting -related bleeding in patients with acute coronary syndrome preoperatively treated with fondaparinux or low-molecular weight heparin. All patients with acute coronary syndrome from the prospective, European multicenter registry on Coronary Artery Bypass Grafting (E-CABG) preoperatively treated with fondaparinux or lowmolecular weight heparin undergoing isolated primary CABG were eligible. The primary outcome measure was severe or massive bleeding defined according to the Universal Definition of Perioperative Bleeding stratified by P2Y12 inhibitor discontinuation. Secondary outcome measures included three additional definitions of major bleeding used in cardiac surgery trials. Propensity score matching was performed to adjust for differences in pre- and perioperative covariates. 1525 patients were included, of whom 276 (18.1%) received fondaparinux and 1249 (81.9%) low-molecular weight heparin preoperatively. In the propensity score-matched cohort (245 pairs), the risk of major bleeding according to the Universal Definition of Perioperative Bleeding severe or massive bleeding (11.8 versus 9.0%, p = 0.285) and the three other major bleeding definitions was similar between the fondaparinux and low-molecular weight heparin cohorts. In conclusion, preoperative treatment with fondaparinux compared to low-molecular weight heparin was associated with similar incidence of perioperative bleeding in patients with acute coronary syndrome undergoing coronary artery bypass grafting.
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