Platelet Transfusion for Ticagrelor Reversal
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Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor reduces the risk of major adverse cardiovascular events in patients with coronary artery disease but increases the risk of bleeding. Restoration of normal hemostasis is desirable in patients treated with these agents who present with life-threatening bleeding and in those who require urgent surgery, but the antiplatelet effects of aspirin and ticagrelor persist for ≈5 days after treatment is stopped. In the absence of specific reversal agents, platelet transfusions are often used in emergency situations, but they may not be effective if active drug is still present at the time of the transfusion.
See Article by Zafar et al
The antiplatelet effect of aspirin can be readily reversed with platelet transfusions because aspirin is cleared from the circulation within an hour of ingestion. Furthermore, by restoring the capacity to produce thromboxane A2, transfusion of 1 to 2 platelet apheresis units fully reverses the antiplatelet effect of aspirin.1 Platelet transfusions may be less effective for ticagrelor reversal,2–11 because ticagrelor and its active metabolite have much longer half-lives than aspirin (9 and 12 hours, respectively).12 Even after active drug is cleared from the circulation, large numbers of platelets may be needed within the first 48 hours to restore platelet function because transfused platelets do not correct the hemostatic defect in platelets inhibited by ticagrelor.
In this issue of Circulation: Cardiovascular Interventions …