Transfusion outcomes in patients undergoing coronary artery bypass grafting treated with prasugrel or clopidogrel: TRITON-TIMI 38 retrospective data analysis

Abstract

Objective: Coronary artery bypass grafting-related bleeding and associated transfusion is a concern with dual antiplatelet therapy in patients with acute coronary syndromes. The objective of the present study was to characterize a potential risk-adjusted difference in transfusion requirements between prasugrel and clopidogrel cohorts.

Methods: The data from 422 patients undergoing isolated coronary artery bypass grafting from the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel Thrombolysis In Myocardial Infarction 38 were analyzed retrospectively.

Results: We found no difference in baseline transfusion risk scores between cohorts. As predicted, the number of units of red blood cells transfused perioperatively correlated with the transfusion risk score (P < .0001). Overall, the 12-hour chest tube drainage volumes and platelet transfusion rates in the prasugrel cohort were significantly greater. However, no statistically significant differences were found in the number of red blood cell transfusions, total hemostatic components transfused, or total blood donor exposure. A significantly greater number of platelet units were transfused postoperatively in the prasugrel patients who underwent surgery within 5 days or less after withdrawal of drug. In an analysis adjusted for the predicted risk of mortality, total donor exposure was not associated with increased mortality.

Conclusions: The use of prasugrel compared with clopidogrel was associated with greater 12-hour chest tube drainage volumes and platelet transfusion rates but without any significant differences in red blood cell transfusions, total hemostatic components transfused, or total blood donor exposure.

Trial registration: ClinicalTrials.gov NCT00097591.

Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Figures

Figure 1

Transfusion risk score (TRS) association with total red blood cell (RBC) transfusion (including whole blood and packed RBCs.) and total hemostatic components (including platelets, cryoprecipitate, and plasma). No significant differences were observed between cohorts.

Figure 2

Predicted probability of mortality as function of total donor exposure and function of total hemostatic components. In analyses adjusted for predicted risk of mortality (using European System for Cardiac Operative Risk Evaluation Score [euroSCORE]), increased mortality risk (all-cause death within 30 days after coronary artery bypass grafting [CABG]) was not associated with total donor exposure (odds ratio, 1.06; 95% confidence interval, 0.98-1.14; P = .15; logistic regression analysis) nor total hemostatic components (odds ratio, 1.05; 95% confidence interval, 0.94-1.17; P = .40; logistic regression analysis). Prasugrel was independently associated with reduction in mortality (prasugrel, 1.2%; clopidogrel, 6.9%; P = .022). Total donor exposure included red blood cells, platelets, cryoprecipitate, and plasma; total hemostatic components included platelets, cryoprecipitate, and plasma.