Early CABG with intraoperative hemoadsorption in patients on ticagrelor: Real-world data from the international Safe and Timely Antithrombotic Removal (STAR) registry

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Revascularization Medicine Pub Date : 2026-01-01 Epub Date: 2025-02-28 DOI:10.1016/j.carrev.2025.02.015

Robert F. Storey , Kambiz Hassan , Anna L. Meyer , Thomas Eberle , Nikolaas deNeve , Matthias Thielmann , Martin H. Bernardi , Nandor Marczin , Ulf Guenther , Bernd Panholzer , Heinrich Maechler , Steven Hunter , Marijana Matejic-Spasic , Daniel Wendt , Efthymios N. Deliargyris , Michael Schmoeckel

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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.

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替格瑞洛患者早期冠脉搭桥伴术中血液吸附：来自国际安全及时抗血栓清除（STAR）登记的真实世界数据

目的：在完成推荐的3天洗脱期之前，超过30%的替格瑞洛患者接受孤立冠状动脉旁路移植术（i-CABG）时发生严重围手术期出血。术中使用聚合物头血液吸附装置去除替格瑞洛是一种被批准的治疗方法，可以减少围手术期出血。方法：目前来自国际安全及时抗血栓清除（STAR）登记中心的分析报告了替格瑞洛患者在完成推荐洗脱之前进行i-CABG的术中血液吸附的结果。根据围手术期出血的通用定义（UDPB）定义评估出血。结果：102例患者（63.8±10.1岁，81.2%为男性）从最后一次给药（TLD）的平均时间（22.8±14.6小时）进行了i-CABG手术。根据TLD到CABG的平均时间（TLD）进行分组：第一组（G1）：结论：术中替格瑞洛去除可以帮助减少i-CABG患者在完成3天洗脱期之前发生的替格瑞洛相关出血。在最后一次替格瑞洛给药后24小时内进行高风险紧急手术会增加出血风险。临床试验注册号：ClinicalTrials.gov: NCT05077124。

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来源期刊

Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.30

自引率

5.90%

发文量

687

审稿时长

36 days

期刊介绍： Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.