Management of Antiplatelet Therapy Before Heart Catheterization

Discontinuation Recommendations

The American College of Chest Physicians recommends that ticagrelor should be discontinued 3-5 days before elective heart catheterization if there is concern for bleeding risk, but can be continued if the procedure is urgent or the thrombotic risk outweighs bleeding concerns 1
Ticagrelor should be discontinued 3-5 days before elective procedures with significant bleeding risk, including heart catheterization, as recommended by the American Heart Association and the American College of Cardiology 1, 2
The recommendation is based on ticagrelor's reversible binding properties and shorter half-life (12 hours) compared to other P2Y12 inhibitors, as stated by the American College of Cardiology 3, 4

For patients at high thrombotic risk, the decision to discontinue ticagrelor should balance thrombotic versus bleeding risks, according to the American College of Cardiology and the American Heart Association 1, 5
For low thrombotic risk patients, discontinuation 3-5 days before the procedure is appropriate, as recommended by the American College of Chest Physicians 1

If the heart catheterization is likely to lead to coronary artery bypass grafting (CABG), ticagrelor should be discontinued 3-5 days before the procedure to minimize bleeding risk, as stated by the American College of Cardiology and the American Heart Association 1, 2
For diagnostic heart catheterization without anticipated intervention, the bleeding risk is lower and may not require discontinuation in urgent cases, according to the American College of Cardiology 3

Antiplatelet therapy should be resumed within 24 hours after the procedure if there are no bleeding complications, as recommended by the American College of Chest Physicians 1
For patients who undergo PCI during catheterization, ticagrelor should be restarted as soon as possible, according to the American College of Cardiology and the American Heart Association 2, 4