TY - JOUR
T1 - Use of adenosine diphosphate receptor inhibitor prior to left ventricular assist device implantation is not associated with increased bleeding
AU - Tibrewala, Anjan
AU - Nassif, Michael E.
AU - Andruska, Adam
AU - Shuster, Jerrica E.
AU - Novak, Eric
AU - Vader, Justin M.
AU - Ewald, Gregory A.
AU - LaRue, Shane J.
AU - Silvestry, Scott
AU - Itoh, Akinobu
N1 - Funding Information:
This study was supported in part by research funds from the National Institutes of Health (NIH grant U10 HL110309, Heart Failure Network). No relationships with industry.
Publisher Copyright:
© 2016, The Japanese Society for Artificial Organs.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Current guidelines recommend adenosine diphosphate receptor inhibitors (ADPRi) be discontinued 5–7 days prior to cardiac surgery due to increased bleeding events, rates of re-exploration, and transfusions. However, the risks of left ventricular assist device (LVAD) implantation in patients taking an ADPRi have not previously been studied. We retrospectively identified 134 eligible patients with ischemic cardiomyopathy that underwent LVAD implantation between July 2009 and August 2013. The cohorts received an ADPRi ≤5 days of surgery (n = 25) versus >5 days prior or not at all (n = 109). Subgroup analyses adjusted for differences in frequency of redo sternotomy between cohorts, excluded patients that received an ADPRi >1 year prior to surgery, and excluded patients with a redo sternotomy. The ADPRi and control groups did not have significant differences in the primary outcomes, intraoperative PRBC units transfused (3.0 vs. 4.0, p = 0.12) or chest tube output within 24 h of surgery (1.66 L vs. 1.80 L, p = 0.61). After adjusting for differences in frequency of redo sternotomy (ADPRi vs. control, 12 vs. 52%, p ≤ 0.001), no significant difference in PRBC units transfused (3.1 vs. 3.5, p = 0.59) or chest tube output (2.04 L vs. 2.04 L, p = 0.98) was seen. No significant difference in 30-day mortality (8.0 vs. 11.0%, p = 0.63), 90-day mortality (16.4 vs. 23.3%, p = 0.42), or length of stay (29.0 vs. 28.0, p = 0.61) was seen. In this single-center experience, use of an ADPRi ≤5 days prior to LVAD implantation was not associated with increased bleeding, length of stay, or mortality.
AB - Current guidelines recommend adenosine diphosphate receptor inhibitors (ADPRi) be discontinued 5–7 days prior to cardiac surgery due to increased bleeding events, rates of re-exploration, and transfusions. However, the risks of left ventricular assist device (LVAD) implantation in patients taking an ADPRi have not previously been studied. We retrospectively identified 134 eligible patients with ischemic cardiomyopathy that underwent LVAD implantation between July 2009 and August 2013. The cohorts received an ADPRi ≤5 days of surgery (n = 25) versus >5 days prior or not at all (n = 109). Subgroup analyses adjusted for differences in frequency of redo sternotomy between cohorts, excluded patients that received an ADPRi >1 year prior to surgery, and excluded patients with a redo sternotomy. The ADPRi and control groups did not have significant differences in the primary outcomes, intraoperative PRBC units transfused (3.0 vs. 4.0, p = 0.12) or chest tube output within 24 h of surgery (1.66 L vs. 1.80 L, p = 0.61). After adjusting for differences in frequency of redo sternotomy (ADPRi vs. control, 12 vs. 52%, p ≤ 0.001), no significant difference in PRBC units transfused (3.1 vs. 3.5, p = 0.59) or chest tube output (2.04 L vs. 2.04 L, p = 0.98) was seen. No significant difference in 30-day mortality (8.0 vs. 11.0%, p = 0.63), 90-day mortality (16.4 vs. 23.3%, p = 0.42), or length of stay (29.0 vs. 28.0, p = 0.61) was seen. In this single-center experience, use of an ADPRi ≤5 days prior to LVAD implantation was not associated with increased bleeding, length of stay, or mortality.
KW - Adenosine diphosphate receptor inhibitor
KW - Bleeding
KW - Clopidogrel
KW - Left ventricular assist device
KW - P2Y12 inhibitor
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U2 - 10.1007/s10047-016-0932-7
DO - 10.1007/s10047-016-0932-7
M3 - Article
C2 - 27830349
AN - SCOPUS:84994418036
SN - 1434-7229
VL - 20
SP - 42
EP - 49
JO - Journal of Artificial Organs
JF - Journal of Artificial Organs
IS - 1
ER -