Biological and pharmacological aspects of perioperative hemorrhagic complications associated with oral platelet-directed antithrombotic agents: Focus on isolated coronary artery bypass grafting and oral irreversible P2Y12 receptor antagonists

Coronary arterial bypass grafting (CABG)—the most common heart surgery performed worldwide—is an effective procedure for treating patients with advanced, obstructive atherothrombotic coronary artery disease, prolonging survival in selected high-risk patients. However, CABG is also associated with hemorrhagic complications, which can impact outcome measures such as perioperative morbidity, mortality, length of hospital stay, and health care expenditures. Recent observations have expanded our understanding of the complex process of hemostasis, fostering a more informed view of CABG-associated bleeding complications. Additional research is warranted to determine whether new antithrombotic drug treatment options, such as reversible P2Y12 receptor antagonists among patients with acute coronary syndromes, will favorably impact these clinically relevant complications.