Timing of Ticagrelor Discontinuation Before Surgery

General Recommendations for Ticagrelor Discontinuation

The American College of Chest Physicians recommends that ticagrelor should be discontinued 3 to 5 days before elective non-cardiac surgery to minimize bleeding risk while maintaining adequate perioperative safety 1
For elective non-cardiac surgery, ticagrelor should be stopped 3 to 5 days before the procedure rather than the traditional 7 to 10 days, as recommended by the American College of Chest Physicians 1, 2
For patients undergoing coronary artery bypass graft (CABG) surgery specifically, ticagrelor should be discontinued at least 5 days before surgery, according to the American Heart Association 3, 4
Resumption of antiplatelet therapy should occur within 24 hours after surgery when hemostasis is achieved, as recommended by the American College of Chest Physicians 1

For CABG surgery, ticagrelor should be discontinued for at least 5 days before elective procedures, as recommended by the American Heart Association 4, 5
For urgent CABG, ticagrelor should be discontinued for at least 24 hours to reduce major bleeding risk, according to the American Heart Association 3, 4

For elective non-cardiac surgery, the 3-5 day discontinuation window is recommended by the American College of Chest Physicians 1
The recommendation may be modified based on individual patient circumstances, particularly surgery-related bleeding risk, as stated by the American College of Chest Physicians 1
Platelet function testing is not routinely recommended to guide perioperative management, according to the American College of Chest Physicians 1

For patients with recent coronary stent placement, elective surgery should be delayed when possible: at least 6 weeks after bare metal stent placement and at least 6 months after drug-eluting stent placement, as recommended by a medical guideline society 6
For patients requiring surgery within 6-12 weeks of stent placement, either continuation of dual antiplatelet therapy or stopping one agent 7-10 days before surgery may be considered, according to the American College of Chest Physicians 1

The decision to discontinue ticagrelor must balance bleeding risk against thrombotic risk, as stated by a medical guideline society 6
For patients with high thrombotic risk requiring urgent surgery, cardiology consultation is recommended before discontinuing ticagrelor, according to a medical guideline society 6
The timing of ticagrelor discontinuation should be individualized based on the specific procedure's bleeding risk and the patient's thrombotic risk, as recommended by the American College of Chest Physicians 1