Coronary Bypass Graft Surgery in Patients on Ticagrelor Therapy Is Not Associated with Adverse Postoperative Outcomes

Background:
Ticagrelor is a reversible selective blocker of P2Y12 receptor, inhibiting platelet aggregation, used in patients with ACS undergoing PCI. The impact of Ticagrelor therapy on clinical outcomes in patients undergoing cardiac surgery is unclear. Ticagrelor usually cannot be stopped before CABG due to the risk of acute stent thrombosis. We aimed to evaluate the safety of surgery under Ticagrelor therapy

Methods:
During April 2015-January 2016, 94 patients underwent CABG in our hospital, divided into two groups: patients preoperatively receiving ticagrelor + acetylsalicylic acid (ASA) (group A, n=29) or ASA alone (group B, N=65) until cardiac surgery. Peri-operative events from admission to discharge were retrospectively collected.

Results:
Preoperative and intra-operative characteristics were similar among the two groups but the patients in group A were younger 61±11 and 65±9 years, p=0.045. Mediastinal/pericardial drainage losses in the first 24 hours were 433±353ml and 491±341ml in group A and B respectively (NS). The mean total Packed cells, Platelets, Fresh Frozen Plasma and Cryoprecipitate transfusions units were 1.5±1.4U and 1.4±1.7U (NS), 2.1±3.3U and 2.8±4.0 U (NS), 0.2±0.6U and 0.7±1.3U ( p=0.072) and 0.2±1.1 U and 0.3±1.7U (NS), respectively. Median hospital lengths of stay for the two groups were 7.8±4.5 and 7.9±4.8 days, respectively. There was no reoperation for bleeding in the two groups. There were no differences in mortality rate, myocardial infarction, stroke, or postoperative renal failure among the groups.

Conclusions:
Receiving ticagrelor until coronary bypass surgery is not associated with increased blood losses and reoperation for bleeding and is not an independent risk factor for increased transfusion requirements and hospital length of stay.