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

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Transfusion outcomes in patients undergoing coronary artery bypass grafting treated with prasugrel or clopidogrel: TRITON-TIMI 38 retrospective data analysis Lawrence T. Goodnough, MD, Peter K. Smith, MD, Jerrold H. Levy, MD, Robert S. Poston, MD, Mary A. Short, MSN, Govinda J. Weerakkody, PhD, LeRoy A. LeNarz, MD The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 4, Pages 1077-1082.e4 (April 2013) DOI: 10.1016/j.jtcvs.2012.07.059 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

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. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1077-1082.e4DOI: (10.1016/j.jtcvs.2012.07.059) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

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. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1077-1082.e4DOI: (10.1016/j.jtcvs.2012.07.059) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Flow diagram for Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38) patients who underwent coronary artery bypass grafting (CABG). The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1077-1082.e4DOI: (10.1016/j.jtcvs.2012.07.059) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Predicted transfusion risk score by treatment group. No statistically significant difference noted in mean predicted transfusion risk score between cohorts (prasugrel, 2.13 vs clopidogrel, 2.31; P = .53; 2-sided P value, analysis of variance). Solid lines represent medians, dashed lines, means; boxes, 25th to 75th percentiles; upper whisker, 90th percentile; plus signs, represent values greater than 90th percentile. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1077-1082.e4DOI: (10.1016/j.jtcvs.2012.07.059) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Mean number of blood product units transfused by treatment group. Number of platelet units transfused and percentage of patients receiving platelet transfusions were statistically greater in prasugrel cohort (red blood cells included packed red blood cells and whole blood; total hemostatic components included platelets, cryoprecipitate, plasma; total donor exposure included red blood cells, platelets, cryoprecipitate, and plasma). CABG, Coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1077-1082.e4DOI: (10.1016/j.jtcvs.2012.07.059) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Correlation of total donor exposure and total hemostatic components with chest tube blood loss at 12 hours. Correlations were similar for both cohorts for both analyses. Total donor exposure included red blood cells, platelets, cryoprecipitate, and plasma; total hemostatic components included platelets, cryoprecipitate, and plasma. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1077-1082.e4DOI: (10.1016/j.jtcvs.2012.07.059) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions