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Early CABG with intraoperative hemoadsorption in patients on ticagrelor: Real-world data from the international Safe and Timely Antithrombotic Removal (STAR) registry
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DOI：10.1016/j.carrev.2025.02.015.png)
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Abstract
En 中文
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 hand 94.9 +/- 37.1 min vs. G2: 4.4 +/- 1 hand 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.
Keywords:
Hemoadsorption
CABG
Washout
Cardiac surgery
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