Variation in preoperative antithrombotic strategy, severe bleeding and use of blood products in coronary artery bypass grafting. Results from the multicenter E-CABG registry

Background: No data exists on inter-institutional differences in terms of adherence to international guidelines regarding the discontinuation of antithrombotics and rates of severe bleeding in coronary artery bypass grafting (CABG). Methods and Results: This is an analysis of 7118 patients from the prospective multicenter E-CABG registry who underwent isolated CABG in 15 European centers. Preoperative pause of P2Y12 receptor antagonists shorter than that suggested by the 2017 ESC guidelines (overall, 11.6%) ranged from 0.7% to 24.8% between centers (adjusted p < 0.0001) and increased the rate of severe-massive bleeding (E-CABG bleeding grades 2-3, OR 1.66, 95%CI 1.27-2.17; UDPB bleeding grades 3-4, OR 1.50, 95%CI 1.16-1.93). The incidence of resternotomy for bleeding (overall, 2.6%) ranged from 0% to 6.9% (adjusted p < 0.0001) and surgical site bleeding (overall, 59.6%) ranged from 0% to 84.6% (adjusted p = 0.003). The rate of the UDPB bleeding grades 3-4 (overall, 8.4%) ranged from 3.7% to 22.3% (p < 0.0001) and of the E-CABG bleeding grades 2-3 (overall, 6.5%) ranged from 0.4% to 16.4% between centers (p < 0.0001). Resternotomy for bleeding (adjusted OR 5.04, 95%CI 2.85-8.92), UDPB bleeding grades 3-4 (adjusted OR 6.61, 95%CI 4.42-9.88) and E-CABG bleeding grades 2-3 (adjusted OR 8.71, 95%CI 5.76-13.15) were associated with an increased risk of hospital/30-day mortality. Conclusions: Adherence to the current guidelines on the early discontinuation of P2Y12 receptor antagonists is of utmost importance to reduce excessive bleeding and early mortality after CABG. Inter-institutional variation should be considered for a correct interpretation of the results in multicentre studies evaluating perioperative bleeding and use of blood products.