Storey Robert F, Hassan Kambiz, Meyer Anna L, Eberle Thomas, deNeve Nikolaas, Thielmann Matthias, Bernardi Martin H, Marczin Nandor, Guenther Ulf, Panholzer Bernd, Maechler Heinrich, Hunter Steven, Matejic-Spasic Marijana, Wendt Daniel, Deliargyris Efthymios N, Schmoeckel Michael
Division of Clinical Medicine, University of Sheffield, Sheffield, UK; NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
Cardiovasc Revasc Med. 2025 Feb 28. doi: 10.1016/j.carrev.2025.02.015.
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.
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.
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).
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.
ClinicalTrials.gov: NCT05077124.
超过30%接受替格瑞洛治疗的患者在完成推荐的3天洗脱期前接受单纯冠状动脉旁路移植术（i-CABG）时会发生严重围手术期出血。使用聚合物珠血液吸附装置在术中去除替格瑞洛是一种已获批准的治疗方法，可能会减少围手术期出血。
来自国际安全及时抗栓清除（STAR）注册研究的当前分析报告了在完成推荐的洗脱期前接受i-CABG的替格瑞洛治疗患者术中血液吸附的结果。出血情况通过围手术期出血通用定义（UDPB）进行评估。
102例患者（63.8±10.1岁，81.2%为男性）在距最后一剂（TLD）平均22.8±14.6小时时接受了i-CABG。根据TLD至CABG的时间创建分组：第1组（G1）：<24小时（n = 61；TLD 12.6±6.5小时）；第2组（G2）：24 - 72小时（n = 41；37.2±10.1小时）。根据欧洲心脏手术风险评估系统（EuroSCORE-II），G1组的风险高于G2组（中位数：4.2%对1.7%，p = 0.006），且急诊指征方面也是如此（66.1%对12.2%，p < 0.001）。手术和体外循环时间相似（G1组：4.3±1.5小时和94.9±37.1分钟，G2组：4.4±1小时和94.7±36.1分钟；p = 无显著差异）。与G2组相比，G1组严重出血（UDPB≥3）和因出血进行再次手术的情况更频繁（分别为14.8%对2.4%，p = 0.047；8.2%对0%，p = 0.08）。G1组任何红细胞或血小板输注也比G2组更频繁（分别为45.9%对26.8%，p = 0.05；59.0%对34.1%，p = 0.014）。
在完成3天洗脱期前接受i-CABG的患者中，术中去除替格瑞洛可能有助于减少与替格瑞洛相关的出血。在最后一剂替格瑞洛后的前24小时内进行的高风险急诊手术出血风险增加。
ClinicalTrials.gov：NCT05077124
