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Ticagrelor Use and Practice Pattern among Canadian Cardiac Surgeons
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  • Ahmed Makhdoum,
  • Subodh Verma,
  • Bobby Yanagawa ,
  • Nitish Dhingra ,
  • Rachel Eikelboom,
  • Thin Vo,
  • Joel Bierer,
  • Jessica Luc,
  • Olina Dagher,
  • Andreanne Cartier,
  • olivier vaillancourt,
  • Kier Forgie,
  • Gianluigi Bisleri,
  • Terrence Yau
Ahmed Makhdoum
University of Toronto

Corresponding Author:[email protected]

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Subodh Verma
University of Toronto
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Bobby Yanagawa
University of Toronto
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Nitish Dhingra
University of Toronto
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Rachel Eikelboom
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Thin Vo
University of Ottawa
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Joel Bierer
Dalhousie University
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Jessica Luc
The University of British Columbia
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Olina Dagher
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Andreanne Cartier
Laval University
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olivier vaillancourt
McGill University
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Kier Forgie
University of Alberta
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Gianluigi Bisleri
University of Toronto
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Terrence Yau
Toronto General Hospital
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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.
03 Apr 2021Submitted to Journal of Cardiac Surgery
03 Apr 2021Submission Checks Completed
03 Apr 2021Assigned to Editor
03 Apr 2021Reviewer(s) Assigned
12 Apr 2021Review(s) Completed, Editorial Evaluation Pending
12 Apr 2021Editorial Decision: Revise Minor
18 Apr 20211st Revision Received
20 Apr 2021Submission Checks Completed
20 Apr 2021Assigned to Editor
20 Apr 2021Reviewer(s) Assigned
27 Apr 2021Review(s) Completed, Editorial Evaluation Pending
27 Apr 2021Editorial Decision: Accept
Aug 2021Published in Journal of Cardiac Surgery volume 36 issue 8 on pages 2793-2801. 10.1111/jocs.15636