Optimizing Timing of CABG in Patients Presenting With ACS and Treated With Ticagrelor
Status:
Unknown status
Trial end date:
2017-08-01
Target enrollment:
Participant gender:
Summary
The administration of Ticagrelor have demonstrated superiority to Clopidogrel in patients
presenting with acute coronary syndrome (ACS) and remains a first line therapy as an adjunct
to aspirin for patients admitted with ACS. The patient population treated with Ticagrelor at
an early time point includes non ST elevation myocardial (NSTEMI) patients and those
undergoing primary angioplasty for ST elevation myocardial infarction (STEMI). It is
estimated that 10-15% of patients presenting with ACS have advanced coronary artery disease
requiring Coronary Artery Bypass Surgery (CABG). The treatment guidelines recommend a delay
of 5-7 days for CABG surgery in these patients for normalization of Ticagrelor induced
platelet inhibition to reduce the risk of peri-operative bleeding. This delay may expose
these high risk patients to adverse cardiac events while waiting for Ticagrelor effect to
wean off. Furthermore, this empirical application of 5-7 day delay in all patients may be
unnecessary due to the significant inter individual variability in response to Ticagrelor.
There is limited data to determine the optimum timing of CABG surgery in ACS patients treated
with Ticagrelor. The present study will determine the optimum timing of CABG in ACS patients
treated with a loading and/or maintenance dose of Ticagrelor.
Phase:
Phase 4
Details
Lead Sponsor:
St. Michael's Hospital, Toronto Unity Health Toronto