Related Experiment Video
Updated: May 6, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Early CABG with intraoperative hemoadsorption in patients on ticagrelor: Real-world data from the international Safe
Robert F Storey1, Kambiz Hassan2, Anna L Meyer3
1Division of Clinical Medicine, University of Sheffield, Sheffield, UK; NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Insights
Intraoperative ticagrelor removal using hemoadsorption may reduce severe bleeding in patients undergoing coronary artery bypass grafting before the recommended 3-day washout. Early procedures (within 24 hours) carry a higher bleeding risk.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Hematology
Background:
- Severe perioperative bleeding affects over 30% of patients on ticagrelor undergoing isolated coronary artery bypass grafting (i-CABG) before the recommended 3-day washout period.
- Intraoperative ticagrelor removal via hemoadsorption is an approved therapy aimed at mitigating this risk.
Purpose of the Study:
- To evaluate the efficacy of intraoperative ticagrelor removal using hemoadsorption in patients undergoing i-CABG before completing the standard 3-day washout.
- To assess bleeding outcomes based on the time from the last ticagrelor dose to surgery.
Main Methods:
- Analysis of data from the international Safe and Timely Antithrombotic Removal (STAR) registry.
- Inclusion of 102 patients undergoing i-CABG on ticagrelor without completing the washout period.
- Assessment of bleeding using the Universal Definition of Perioperative Bleeding (UDPB) and categorization into groups based on time from last ticagrelor dose (<24h vs. 24-72h).
Main Results:
- Patients undergoing i-CABG within 24 hours of their last ticagrelor dose (Group 1) presented higher risk profiles (EuroSCORE-II, emergency indication) compared to those treated between 24-72 hours (Group 2).
- Severe bleeding (UDPB≥3) was significantly more frequent in Group 1 (14.8%) versus Group 2 (2.4%) (p=0.047).
- Red blood cell and platelet transfusions were also more common in Group 1 (45.9% and 59.0%, respectively) compared to Group 2 (26.8% and 34.1%, respectively).
Conclusions:
- Intraoperative ticagrelor removal via hemoadsorption appears to be a viable strategy for reducing bleeding complications in patients undergoing i-CABG before completing the recommended washout.
- High-risk emergency procedures performed within 24 hours of the last ticagrelor dose are associated with an elevated risk of perioperative bleeding.
Objectives:
Severe perioperative bleeding occurs in over 30 % of patients on ticagrelor undergoing isolated coronary artery bypass grafting (i-CABG) before completing the recommended 3-day washout. Intraoperative ticagrelor removal with a polymer bead hemoadsorption device is an approved therapy that may reduce perioperative bleeding.
Methods:
The current analysis from the international Safe and Timely Antithrombotic Removal (STAR) registry reports outcomes with intraoperative hemoadsorption in patients on ticagrelor undergoing i-CABG before completing the recommended washout. Bleeding was assessed by the Universal Definition of Perioperative Bleeding (UDPB) definition.
Results:
102 patients (63.8 ± 10.1 years, 81.2 % male) underwent i-CABG at mean time from last dose (TLD) of 22.8 ± 14.6 h. Groups were created based on TLD to CABG: Group-1 (G1): <24 h (n = 61; TLD 12.6 ± 6.5 h); Group-2 (G2): 24-72 h (n = 41; 37.2 ± 10.1 h). G1 was higher risk than G2 based on EuroSCORE-II (median: 4.2 % vs. 1.7 %, p = 0.006) and emergency indication (66.1 % vs. 12.2 %, p < 0.001). Operation and cardiopulmonary bypass durations were similar (G1: 4.3 ± 1.5 h and 94.9 ± 37.1 min vs. G2: 4.4 ± 1 h and 94.7 ± 36.1 min, p = ns). Severe bleeding (UDPB≥3) and re-operations for bleeding were more frequent in G1 vs. G2 (14.8 % vs. 2.4 %, p = 0.047, and 8.2 % vs. 0 %, p = 0.08, respectively). Any transfusion of red blood cells or platelets was also more frequent in G1 vs. G2 (45.9 % vs. 26.8 %, p = 0.05 and 59.0 % vs. 34.1 %, p = 0.014, respectively).
Conclusions:
Intraoperative ticagrelor removal may help reduce ticagrelor-related bleeding in patients undergoing i-CABG before completing the 3-day washout. High risk emergency procedures within the first 24 h of last ticagrelor dose have an increased bleeding risk.
Clinical Trial Registry Number:
ClinicalTrials.gov: NCT05077124.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:28Acute Coronary Syndrome IV: Interprofessional Care