Is a Traditional 5-to-7–Day Hold of Ticagrelor Necessary Prior to CABG?

In theory, a short interruption of ticagrelor prior to coronary artery bypass graft (CABG) surgery could result in an unacceptably high bleeding risk. However, prolonged interruption could also lead to another coronary event or lengthen the hospital stay. In an open-label, randomized trial, investigators tested the safety of a shorter interruption (2–3 days) against a traditional longer interruption of ticagrelor (5–7 days) prior to CABG in 143 patients with acute coronary syndromes.

The primary outcome of periprocedural bleeding occurred in three patients (≈5%) in each group and met the criteria for noninferiority (absolute difference, −0.6%; 95% CI, −8.3% to 7.1%; noninferiority margin, 8%). No fatal bleeding occurred. A shorter interrupti…