Timing of Coronary Artery Bypass Surgery Among Patients With Acute Coronary Syndromes Initially on Ticagrelor

Ottawa Heart Institute Research Corporation143 enrolled

Overview

Ticagrelor, a more potent P2Y12 inhibitor, has been shown to reduce major adverse cardiac events (MACE) in acute coronary syndromes (ACS). It is increasingly used as a first line therapy in ACS. However, more potent P2Y12 inhibition has been associated with increased bleeding. This may be of particular concern for patients with ACS who require coronary artery bypass surgery (CABG). In particular, the timing for cessation of ticagrelor before proceeding to CABG is unclear. RAPID TITRATE CABG is a randomized vanguard study to evaluate the feasibility and preliminary safety of a strategy of early versus delayed CABG in ACS patients initially treated with ticagrelor and to identify potential mechanisms underlying benefits or complications of early bypass surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

143

Conditions

Acute Coronary Syndrome

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * ACS patient referred for CABG and have received \>= 1 dose of ticagrelor before decision for CABG made Exclusion Criteria: Patients are excluded if they: * refuse consent for enrollment * are deemed to require immediate CABG (Day 0 or day 1) * have a ST-elevation myocardial infarction (STEMI )initially treated with primary PCI * are undergoing concurrent valve surgery * are intolerant or allergic to aspirin * have been on an oral anticoagulant (including a vitamin K antagonist or a NOAC) * received adjuvant therapy with a glycoprotein IIbIIIa inhibitor * have a co-morbidity with life-expectancy of \< 1 year * have active bleeding

Outcomes

Primary Outcomes

Severe-massive bleeding

Class 3 or 4 UDPB (universal definition for peri-operative bleeding)

Time frame: 24 hours post CABG

12-hour chest tube drainage

Chest tube drainage in the first 12 hours after bypass surgery

Time frame: 12 hours post CABG