Work

Preoperative dual antiplatelet therapy increases risk after urgent coronary bypass surgery: A Netherlands heart registration study

Year: 2025

Type: article

Abstract: Objective: Dual antiplatelet therapy (DAPT) is standard care after acute coronary syndrome, but its perioperative management before urgent coronary artery bypass grafting (CABG) remains controversial. By using data from the Netherlands Heart Registration, a nationwide Dutch registry, we sought to assess the impact of recent preoperative DAPT on surgical and postoperative outcomes in patients undergoing urgent CABG after acute coronary syndrome. Methods: In this multicenter retrospective cohort study, 6913 patients undergoing urgent isolated CABG within 90 days of acute coronary syndrome were analyzed. Patients receiving DAPT (aspirin + P2Y12 inhibitor within 48 hours preoperatively) were compared with those on aspirin alone. Propensity score matching and multivariable logistic regression were used to adjust for confounding. Results: Recent DAPT use was independently associated with increased perioperative bleeding complications, including greater rates of reintervention (odds ratio [OR], 1.78), transfusion (OR, 1.85), and surgical mortality (OR, 2.02). Considerable interhospital variation in DAPT use (12%-84%) underscores inconsistent practices across Dutch cardiac surgery centers. Conclusions: Recent DAPT before urgent CABG is independently associated with significantly increased perioperative bleeding risk, transfusion requirements, and mortality. The substantial interhospital variation in DAPT use across Dutch cardiac surgery centers further underscores the need for standardized, evidence-based guidelines to optimize antiplatelet management in high-risk patients with coronary syndrome requiring surgical revascularization.

Source: JTCVS Open

DOI: 10.1016/j.xjon.2025.09.045

Authors: Heleen J.C.L. Apostel, Maaike M. Roefs, Amon Heijne, Ewald M. Bronkhorst, Edgar J. Daeter, Wilson W.L. Li

Institutions: Radboud University Nijmegen, Radboud University Medical Center, Netherlands Heart Registration, St. Antonius Ziekenhuis

Language: English

Topic: Antiplatelet Therapy and Cardiovascular Diseases

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,431