P2Y12 Inhibitor Cessation Before CABG — EECC MCQ

Correct answer: A — Ticagrelor should be discontinued at least 3-5 days before CABG to reduce perioperative bleeding risk, though urgent surgery can proceed earlier with accepted increased bleeding risk if delay would be harmful

The 2023 ESC ACS Guidelines recommend P2Y12 inhibitor discontinuation before elective CABG: ticagrelor 3-5 days (shorter than clopidogrel 5-7 days due to ticagrelor's reversible binding); prasugrel 7 days (irreversible, potent); clopidogrel 5 days. Ticagrelor's reversible P2Y12 binding means platelet function recovers faster after discontinuation compared with the irreversible thienopyridines. For urgent CABG (cannot wait 3-5 days), surgery can proceed with accepted higher bleeding risk — platelet transfusion may be needed. Aspirin is generally continued through CABG. Cangrelor (IV, ultra-short-acting P2Y12 inhibitor) can bridge the gap in very high ischaemic risk patients awaiting CABG, discontinued 1 hour before surgery.

Reference: ESC (2023): ACS Guidelines