Early vs Delayed Bypass Surgery in Patients With Acute Coronary Syndrome Receiving Ticagrelor: The RAPID CABG Randomized Open-Label Noninferiority Trial.
Summary
In ACS patients previously treated with ticagrelor and requiring CABG, performing surgery 2–3 days after stopping ticagrelor was noninferior to delaying 5–7 days for severe/massive perioperative bleeding and chest tube output. Early surgery also reduced hospital length of stay.
Key Findings
- Per-protocol severe/massive UDPB: 4.6% (early) vs 5.2% (delayed); noninferiority met (P=0.03).
- 12-hour chest tube drainage noninferior: median 470 mL (early) vs 495 mL (delayed).
- Hospital stay shorter with early strategy: median 9 vs 12 days (P<0.001).
Clinical Implications
For ACS patients on ticagrelor proceeding to CABG, anesthesia and surgical teams can schedule surgery 2–3 days after cessation rather than waiting 5–7 days, potentially shortening ICU and hospital stays while maintaining bleeding safety.
Why It Matters
High-quality randomized evidence addresses a frequent perioperative dilemma on antiplatelet timing for CABG and supports accelerating surgical care without excess bleeding.
Limitations
- Open-label design may introduce performance bias.
- Modest sample size (n=143) limits precision for rare bleeding events.
Future Directions
Replicate findings in larger, multicenter pragmatic trials and evaluate cost-effectiveness and protocols integrating point-of-care platelet function testing.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Randomized controlled trial demonstrating noninferiority for bleeding outcomes.
- Study Design
- OTHER