Ticagrelor discontinuation resulted in acceptable mean platelet aggregation (38 ±23 U) at 72 hours in patients awaiting urgent CABG, though 25% of patients remained below the safe threshold.
Observational (n=25)
How does platelet function recover over time after ticagrelor withdrawal in patients awaiting urgent coronary surgery?
Platelet function recovers to acceptable levels in most patients 72 hours after ticagrelor discontinuation, but large interindividual variability suggests platelet function testing may be useful for timing urgent CABG.
Objective: Dual antiplatelet therapy with ticagrelor and aspirin is associated with an increased risk of perioperative bleeding complications. Current guidelines recommend therefore discontinuation of ticagrelor 5 days before surgery to allow sufficient recovery of platelet function. It is not known how the time to recovery varies between individual patients after discontinuation of ticagrelor. Methods: Twenty-five patients accepted for urgent coronary artery bypass surgery and treated with ticagrelor and aspirin were included in a prospective observational study. Platelet aggregation was evaluated with impedance aggregometry at five timepoints 12-96 h after discontinuation of ticagrelor. In a subset of patients ( n = 15), we also tested the ex vivo efficacy of platelet concentrate supplementation on platelet aggregation. Results: There was a gradual increase in mean adenosine diphosphate-induced platelet aggregation after discontinuation of ticagrelor. After 72 h, mean aggregation was 38 ±23 aggregation units (U), which is above a previously suggested cut-off of 22 U, when patients can be operated without increased bleeding risk. However, there was a large interindividual variability (range 4‒88 U at 72 h) and 6/24 patients (25%) had <22 U after 72 h. Ex vivo administration of platelet concentrate did not improve adenosine diphosphate-induced aggregation at any timepoint after ticagrelor discontinuation. Conclusions: Adenosine diphosphate-induced aggregation was acceptable after 72 h in the majority of patients but with a large interindividual variability. Due to the large variability, platelet function testing may prove to be a valuable tool in timing of surgery in patients with ongoing or recently stopped ticagrelor treatment. Adenosine diphosphate-induced aggregation was not improved by addition of platelet concentrate.
Hansson et al. (Fri,) conducted a observational in Patients awaiting urgent coronary artery bypass surgery (n=25). Ticagrelor discontinuation was evaluated on Adenosine diphosphate-induced platelet aggregation at 72 hours. Ticagrelor discontinuation resulted in acceptable mean platelet aggregation (38 ±23 U) at 72 hours in patients awaiting urgent CABG, though 25% of patients remained below the safe threshold.