{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:46Z","timestamp":1753876306089,"version":"3.41.2"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Antiplatelet therapy increases the risk of bleeding and transfusion in patients undergoing extracorporeal circulation. Reduced goal-directed anticoagulation is a personalized approach to reduce the anticoagulation based on a lower targeted activated clotting time. We assessed whether reduced goal-directed anticoagulation using optimized extracorporeal circulation alleviates the risk of severe bleeding in patients treated by dual antiplatelet therapy (DAPT) compared to aspirin alone during coronary artery bypass grafting (CABG).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>A total of 2275 patients undergoing CABG from 2002 to 2022 were selected after propensity matching from a retrospective cohort of 3018 patients. Patients treated with a combination of aspirin and prasugrel or ticagrelor or clopidogrel were included in the DAPT group (n\u2009=\u20091111). Patients treated with aspirin alone (ASA) constituted the control group (n\u2009=\u20091164). Optimized extracorporeal circulation was conducted under reduced systemic anticoagulation with a target activated clotting time 250\u2009s. Severe bleeding was assessed using 3 validated scores of bleeding: UDPB, E-CABG, and BARC-4.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>While all scores showed low ranges of severe bleeding (&amp;lt;6%), they were significantly higher after DAPT compared to ASA (P values for UDPB, E-CABG, and BARC-4 at 0.016, 0.006, and 0.063, respectively). Higher maximal activated clotting time was associated with higher rate of transfusion (P\u2009&amp;lt;\u20090.001) and bleeding (P\u2009&amp;lt;\u20090.001) after multivariate adjustment. Mortality was 1.24% in DAPT vs 0.94% in ASA group (P = NS), whereas cardiac death, myocardial infarction, stroke, and transient ischaemic attack were low (&amp;lt;1%) and similar between groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Despite higher bleeding under DAPT compared to ASA alone, optimized extracorporeal circulation with reduced goal-directed anticoagulation alleviated severe bleeding which remained low in patients undergoing CABG.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezae436","type":"journal-article","created":{"date-parts":[[2024,12,14]],"date-time":"2024-12-14T12:12:54Z","timestamp":1734178374000},"source":"Crossref","is-referenced-by-count":0,"title":["Postoperative bleeding in myocardial revascularization under cardiopulmonary bypass for patients treated with aspirin or dual antiplatelet therapy using reduced goal-directed anticoagulation"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5433-2607","authenticated-orcid":false,"given":"Maroua","family":"Eid","sequence":"first","affiliation":[{"name":"Cardiac Surgery Department, University Hospital of Angers , 4 Rue Larrey , Angers, 49100,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3065-9247","authenticated-orcid":false,"given":"Simon","family":"Dang Van","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Department, University Hospital of Angers , 4 Rue Larrey , Angers, 49100,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yveline","family":"Hamon","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Department, University Hospital of Angers , 4 Rue Larrey , Angers, 49100,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1293-1120","authenticated-orcid":false,"given":"Emmanuel","family":"Rineau","sequence":"additional","affiliation":[{"name":"Anaesthesiology and Intensive Care Department, University Hospital of Angers , 4 Rue Larrey , Angers, 49100,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7056-9257","authenticated-orcid":false,"given":"J\u00e9r\u00e9mie","family":"Riou","sequence":"additional","affiliation":[{"name":"Methodology and Biostatistics Department to Clinical Research and Innovation, University Hospital of Angers , 4 Rue Larrey , Angers, 49100,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4176-3739","authenticated-orcid":false,"given":"Christophe","family":"Baufreton","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Department, University Hospital of Angers , 4 Rue Larrey , Angers, 49100,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,12,2]]},"reference":[{"key":"2024123123361479500_ezae436-B1","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S0022-5223(19)41500-6","article-title":"Heparin therapy during extracorporeal circulation. 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