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
cardiac surgeons. Results: A total of 70 Canadian 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 prior to coronary artery bypass graft procedure in a stable
patient; 44.3% wait 3 days and 32.9% wait 4 days or longer. Currently,
14.3% of cardiac surgeons prophylactically give platelet transfusions
and/or 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.