Ticagrelor use and practice patterns among Canadian cardiac surgeons.
ACS
CABG
survey
ticagrelor
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
revised:
19
04
2021
received:
03
04
2021
accepted:
27
04
2021
pubmed:
25
5
2021
medline:
14
7
2021
entrez:
24
5
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
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
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
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
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.
Substances chimiques
Platelet Aggregation Inhibitors
0
Clopidogrel
A74586SNO7
Ticagrelor
GLH0314RVC
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2793-2801Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
CURE Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494-502.
Wallentin L , Becker RC , Budaj A , et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361:1045-1057.
Wiviott SD , Braunwald E , McCabe CH , et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357:2001-2015.
Dobesh PP , Oestreich JH . Ticagrelor: pharmacokinetics, pharmacodynamics, clinical efficacy, and safety. Pharmacotherapy. 2014;34:1077-1090.
Bonaca MP , Bhatt DL , Cohen M , et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015;372:1791-1800.
Bhatt DL , Steg PG , Mehta SR , et al. Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI): a phase 3, placebo-controlled, randomised trial. Lancet. 2019;394:1169-1180.
Johnston SC , Amarenco P , Denison H , et al. Ticagrelor and aspirin or aspirin alone in acute ischemic stroke or TIA. N Engl J Med. 2020;383:207-217.
Hansson EC , Jidéus L , Åberg B , et al. Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study. Eur Heart J. 2016;37:189-197.
Gherli R , Mariscalco G , Dalén M , et al. Safety of preoperative use of ticagrelor with or without aspirin compared with aspirin alone in patients with acute coronary syndromes undergoing coronary artery bypass grafting. JAMA Cardiol. 2016;1:921-928.
Tomšič A , Schotborgh MA , Manshanden JS , Li WW , de Mol BA . Coronary artery bypass grafting-related bleeding complications in patients treated with dual antiplatelet treatment. Eur J Cardiothorac Surg. 2016;50:849-856.
Alraddadi H , Belley-Cote E , Shehata N , Mazer D , Whitlock RP . Transfusion requirements in cardiac Surgery III (TRICS III), Ticagrelor Substudy. Eur Heart J. 2020;41:ehaa946.1471 (Abstract).
Ranucci M , Baryshnikova E , Castelvecchio S , Pelissero G . Surgical and Clinical Outcome Research (SCORE) Group. Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thorac Surg. 2013;96:478-485.
Dyke C , Aronson S , Dietrich W , et al. Universal definition of perioperative bleeding in adult cardiac surgery. J Thorac Cardiovasc Surg. 2014;147:1458-1463.
Jennings L , Curry BJ , Bhatt DL , et al. 2350 Evaluation of the pharmacodynamics of a ticagrelor reversal agent PB2452 [Abstract]. Eur Heart J. 2019;40:ehz748.0137.
Bhatt DL , Pollack CV , Weitz JI , et al. Antibody-based ticagrelor reversal agent in healthy volunteers. N Engl J Med. 2019;380:1825-1833.
Gurbel PA , Bliden KP , Butler K , et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation. 2009;120:2577-2585.
Godier A , Garrigue D , Lasne D , et al. Management of antiplatelet therapy for non elective invasive procedures of bleeding complications: proposals from the French working group on perioperative haemostasis (GIHP), in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR). Anaesth Crit Care Pain Med. 2019;38:289-302.
Godier A , Taylor G , Gaussem P . Inefficacy of platelet transfusion to reverse ticagrelor. N Engl J Med. 2015;372:196-197.
Teng R , Carlson GF , Nylander S , Andersson TL . Effects of autologous platelet transfusion on platelet inhibition in ticagrelor-treated and clopidogrel-treated subjects. J Thromb Haemost. 2016;14:2342-2352.
Valgimigli M , Bueno H , Byrne RA , et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2018 Jan 1;2018(53):34-78.
Writing Committee Members*, Hillis LD , Smith PK , Anderson JL , et al. ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124:2610-2642.
Mehta SR , Bainey KR , Cantor WJ , et al. 2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology focused update of the guidelines for the use of antiplatelet therapy. Can J Cardiol. 2018;34(3):214-233.
Buchanan A , Newton P , Pehrsson S , et al. Structural and functional characterization of a specific antidote for ticagrelor. Blood. 2015;125:3484-3490.
Siegal DM , Curnutte JT , Connolly SJ , et al. Andexanet alfa for the reversal of factor Xa inhibitor activity. N Engl J Med. 2015;373:2413-2424.
Pollack Jr. CV , Reilly PA , Eikelboom J , et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015;373:511-520.