Bleeding complications after dual antiplatelet therapy with ticagrelor versus dual antiplatelet therapy with clopidogrel-a propensity-matched comparative study of two antiplatelet regimes in off-pump coronary artery bypass grafting.

Purpose: Ticagrelor combined with aspirin had shown better saphenous vein graft patency than aspirin with clopidogrel after off-pump coronary artery bypass grafting. However, the safety of this drug in regard to bleeding complications remains unknown. The aim of our study was to assess the bleeding complications of dual antiplatelet therapy with aspirin and ticagrelor compared with aspirin and clopidogrel within the first 3 months after off-pump surgery.

Methods: Three hundred eighty-two consecutive patients who were prescribed aspirin with ticagrelor (ticagrelor group) were compared with 660 patients who received aspirin and clopidogrel (clopidogrel group). After propensity matching, 144 patients in each group were compared for bleeding events and major adverse cardiac and cerebral events. Major bleeding was defined as composite outcome of re-exploration for bleeding, any fatal bleeding, intracranial bleeding, and any bleeding requiring hospitalization.

Results: Patients in the ticagrelor group had more incidence of re-exploration for bleeding ( = 0.042), pericardial effusion requiring drainage ( = 0.007), readmissions ( < 0.01), gastrointestinal bleeding ( = 0.01), and major bleeding (5.8% vs. 2.1%,  < 0.01, OR 2.8 (1.43-5.58)). After propensity analysis, gastrointestinal bleed ( = 0.024), major bleeding (7.6% vs.1.4%,  < 0.001, OR 5.8 (1.28-26.97)), length of ICU stay ( = 0.039), and readmissions ( = 0.003, OR 11.83 (1.51-92.86)) were more in the ticagrelor group. Major adverse cardiac and cerebral events were similar between the groups.

Conclusion: Dual antiplatelet therapy with aspirin and ticagrelor increased gastrointestinal bleeding events, major bleeding events, and readmission rates compared with aspirin and clopidogrel after off-pump coronary artery bypass grafting.