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SHR Neuro Cancer Cardio Lipid Metab Microb
Storey, RF; Hassan, K; Meyer, AL; Eberle, T; deNeve, N; Thielmann, M; Bernardi, MH; Marczin, N; Guenther, U; Panholzer, B; Maechler, H; Hunter, S; Matejic-Spasic, M; Wendt, D; Deliargyris, EN; Schmoeckel, M.
Early CABG with intraoperative hemoadsorption in patients on ticagrelor: Real world data from the international Safe and Timely Antithrombotic Removal (STAR) registry.
Cardiovasc Revasc Med. 2025;
Doi: 10.1016/j.carrev.2025.02.015
PubMed
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- Co-authors Med Uni Graz
- Mächler Heinrich
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- Abstract:
- 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.