Stent Thrombosis After Short-term Discontinuation of Ticagrelor for Coronary Artery Bypass Grafting

Area of Science:

• Cardiology
• Vascular Surgery
• Pharmacology

Background:

• Optimal antithrombotic management for patients with recent coronary stents undergoing open-heart surgery is unclear due to limited clinical evidence.
• Drug-eluting stents (DES) require careful consideration of antiplatelet therapy duration.
• Coronary artery bypass grafting (CABG) necessitates a balance between preventing thrombotic events and surgical bleeding risks.

Observation:

• A case report details stent thrombosis in a patient who stopped a P2Y12 inhibitor (ticagrelor) for three days prior to CABG.
• The patient had recently received coronary stents, highlighting a potential vulnerability during the perioperative period.
• Discontinuation of dual antiplatelet therapy (DAPT) is a known risk factor for stent thrombosis.

Findings:

• Short-term withdrawal of P2Y12 inhibitors, even for a few days, can precipitate acute stent thrombosis in patients with recently implanted coronary stents.
• The specific timing and duration of antiplatelet drug cessation significantly impact thrombotic risk.
• This case underscores the potential for catastrophic thrombotic events when antiplatelet therapy is interrupted before major cardiac surgery.

Implications:

• Minimizing the duration of P2Y12 inhibitor withdrawal before CABG is essential for patients with recent DES implantation.
• Further clinical studies are needed to establish evidence-based guidelines for antithrombotic therapy in this high-risk population.
• Clinicians should carefully weigh the risks of stent thrombosis against bleeding complications when managing antiplatelet therapy perioperatively.