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Ticagrelor cessation: early CABG non-inferior to delayed surgery

Presented By
Dr Derek So, University of Ottowa Heart Institute, Canada
AHA 2021
Early surgery, 2–3 days after the termination of ticagrelor treatment, was non-inferior to delayed surgery by 5–7 days regarding severe or massive bleeding in patients with acute coronary syndrome (ACS). The RAPID CABG trial was the first randomised controlled study assessing an early coronary artery bypass graft (CABG) surgery strategy in this population [1]. The previous phase 3 PLATO trial (NCT00391872) showed that patients with ACS undergoing CABG surgery within 1 day of ticagrelor termination had higher mortality rates, mostly caused by perioperative bleeding, than patients who had a longer period of ticagrelor cessation before surgery [2]. The current North American guidelines recommend a minimum of 5–7 days between termination of ticagrelor and non-urgent CABG surgery, whereas the ESC supports a minimum waiting period of 3 days for this procedure. Thus, the ...

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