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. 2025 Feb 28:S1553-8389(25)00065-X.
doi: 10.1016/j.carrev.2025.02.015. Online ahead of print.

Early CABG with intraoperative hemoadsorption in patients on ticagrelor: Real world data from the international Safe and Timely Antithrombotic Removal (STAR) registry

Robert F Storey  1 , Kambiz Hassan  2 , Anna L Meyer  3 , Thomas Eberle  4 , Nikolaas deNeve  5 , Matthias Thielmann  6 , Martin H Bernardi  7 , Nandor Marczin  8 , Ulf Guenther  9 , Bernd Panholzer  10 , Heinrich Maechler  11 , Steven Hunter  12 , Marijana Matejic-Spasic  13 , Daniel Wendt  14 , Efthymios N Deliargyris  15 , Michael Schmoeckel  16
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Free article

Early CABG with intraoperative hemoadsorption in patients on ticagrelor: Real world data from the international Safe and Timely Antithrombotic Removal (STAR) registry

Robert F Storey et al. Cardiovasc Revasc Med. .
Free article

Abstract

Objectives: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Clinical trial registry number: ClinicalTrials.gov: NCT05077124.

Keywords: CABG; Cardiac surgery; Hemoadsorption; Ticagrelor removal; Washout.

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Conflict of interest statement

Declaration of competing interest Robert Storey: Research grants and personal fees from AstraZeneca and Cytosorbents; and personal fees from Abbott, Afortiori Development/Thrombolytic Science, Alfasigma, Boehringer Ingelheim/Lilly, Bristol Myers Squibb/Johnson & Johnson, Chiesi, Daiichi Sankyo, Idorsia, Novartis, Novo Nordisk, Pfizer, PhaseBio and Tabuk. Kambiz Hassan: Personal speaker and travel fees from Cytosorbents. Anna L. Meyer: Travel expenses from Abiomed. Thomas Eberle: Personal fees from CSL Behring. Nikolaas deNeve: Nothing to disclose. Matthias Thielmann: Research grants (institutional) and personal speaker fees from Cytosorbents. Martin Bernardi: Research grants from Cytosorbents. Nandor Marczin: Personal lecture fees from Cytosorbents. Ulf Guenther: Nothing to disclose. Bernd Panholzer: Research grants and lecture fees from Abbott, Abiomed/Johnsen&Johnsen, Advitos, Orion Pharma, Carmat. Heinrich Maechler: Nothing to disclose. Marijana Matejic-Spasic: Full-time employee of CyotSorbents Europe GmbH. Daniel Wendt: Full-time employee of CyotSorbents Europe GmbH. Efthymios N. Deliargyris: Full-time employee of CyotSorbents Inc., NJ, USA. Michael Schmoeckel: Research grant and personal fees from CytoSorbents.

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