What is the risk of major bleeding complications when CABG is performed within 24 hours after discontinuation of clopidogrel?
The risk of major bleeding complications is increased when CABG is performed within 24 hours after discontinuation of clopidogrel. In the TRITON-TIMI 38 trial, the incidence of CABG-related major bleeding was higher in patients treated with prasugrel than in patients treated with clopidogrel. In patients who undergo CABG 1 to 4 days after discontinuation of clopidogrel, it appears that the incidence of life-threatening bleeding is not significantly increased, but an increase in blood transfusions is seen. In the PLATO trial, the rates of major bleeding and transfusion requirements were similar between patients treated with ticagrelor and patients treated with clopidogrel. The more rapid recovery of platelet function in pharmacokinetic studies suggests that the risk of bleeding may be lower with ticagrelor than with clopidogrel. 