Key result
Continuing ticagrelor combined with aspirin until one day before coronary artery bypass graft surgery did not significantly increase the risk of major perioperative bleeding complications compared to aspirin alone (27% vs 26%).
Why the study?
Stopping ticagrelor before CABG may increase acute stent thrombosis risk, making the perioperative management of these patients challenging.
Does continuing ticagrelor combined with ASA until 1 day before surgery increase bleeding complications in patients undergoing CABG compared to ASA alone?
Observational (n=161)
No
Does continuing ticagrelor combined with ASA until 1 day before surgery increase bleeding complications in patients undergoing CABG compared to ASA alone?
Continuing ticagrelor until one day prior to CABG surgery does not appear to increase the risk of major perioperative bleeding complications compared to aspirin alone.
Answers are grounded in this paper and cite their sources.
May allow shorter ticagrelor discontinuation before CABG; leaves open need for randomized confirmation.
BACKGROUND: Management of patients treated with Ticagrelor is challenging, as stopping Ticagrelor prior to coronary bypass graft surgery (CABG) may increase the risk of acute stent thrombosis. The aim of the study was to compare bleeding complications in patients treated with ticagrelor combined with acetylsalicylic acid (ASA) versus ASA alone until 1 day before surgery. METHODS: Bleeding complications, defined as the composite of red blood cell transfusion ≥1000 ml, chest drainage ≥2000 ml, and bleeding requiring surgical re-exploration, were compared in 161 patients, with 101 on preoperative acetylsalicylic acid (ASA) alone (group A) and 65 on ticagrelor + ASA (group B). RESULTS: There were no differences in bleeding complications between the two groups (26% vs. 27% in group A and B, respectively), with similar chest drainage in the first 24 h (569 ± 393 ml and 649 ± 427 ml, respectively). CONCLUSIONS: Continuing ticagrelor until coronary artery bypass surgery was not associated with increased bleeding complications, suggesting that continued management with ticagrelor until surgery may be safe.
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Diab et al. (2021) conducted an observational in Coronary Artery Disease requiring CABG (n=161). Ticagrelor + Acetylsalicylic acid (ASA) vs. Acetylsalicylic acid (ASA) alone was evaluated on Composite of red blood cell transfusion ≥1000 ml, chest drainage ≥2000 ml, and bleeding requiring surgical re-exploration (p=NS). Continuing ticagrelor combined with aspirin until one day before coronary artery bypass graft surgery did not significantly increase the risk of major perioperative bleeding complications compared to aspirin alone (27% vs 26%).
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