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.