Ticagrelor use and practice patterns among Canadian cardiac surgeons. Issue 8 (24th May 2021)

• Record Type: Journal Article
• Authors: Makhdoum, Ahmad; Dhingra, Nitish K.; Kirubaharan, Aathmika; Eikelboom, Rachel; Luc, Jessica; Dagher, Olina; Bierer, Joel; Cartier, Andreanne; Vaillancourt, Olivier; Vo, Thin X.; Forgie, Keir; Bisleri, Gianluigi; Yau, Terrence M.; Verma, Subodh; Yanagawa, Bobby
• Is Part Of: Journal of cardiac surgery. Volume 36:Issue 8(2021)
• Page Start: 2793
• Page End: 2801
• Publication Date: 2021-05-24
• Subjects: ACS -- CABG -- survey -- ticagrelor; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.15636
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Background and Aim: The P2Y12 platelet receptor inhibitor ticagrelor is widely used in patients following acute coronary syndromes or in those who have received coronary stents. Bentracimab is a monoclonal antibody‐based reversal agent that is being formally evaluated in a Phase 3 clinical trial. Here, we probe the knowledge, attitudes, and practice patterns of cardiac surgeons regarding their perioperative management of ticagrelor and potential application of a ticagrelor reversal agent. Methods: A questionnaire was developed by a working group of cardiac surgeons to inquire into participants' practices and beliefs regarding ticagrelor and disseminated to practicing, Canadian‐trained cardiac surgeons. Results: A total of 70 Canadian‐trained cardiac surgeons participated. Bleeding risk was identified as the most significant consideration when surgically revascularizing ticagrelor‐treated patients (90%). There is variability in the duration of withholding ticagrelor before coronary artery bypass graft procedure in a stable patient; 44.3% wait 3 days and 32.9% wait 4 days or longer. Currently, 15.7% of cardiac surgeons prophylactically give platelet transfusions and fresh frozen plasma intraoperatively following protamine infusion in patients who have recently received ticagrelor. Interestingly, 47.1% of surveyed surgeons were aware of a reversal agent for ticagrelor, 91.4% of cardiac surgeons would consider utilizing a ticagrelor reversal agent if available, and 51.4% acknowledged that the introduction of such an agent would be a major advance in clinical practice. Conclusions: The present survey identified ticagrelor‐related bleeding as a major concern for cardiac surgeons. Surgeons recognized the significant unmet need that a ticagrelor reversal agent would address.