Intraoperative Ticagrelor Removal Reduces Major Bleeding After Urgent CABG: A Pooled Analysis of the STAR-T Randomized Trial and the International STAR Registry

All articles of this category (opens in new window) Background: Guidelines recommend ticagrelor discontinuation for at least 72 hours prior to CABG. A novel polymer hemoadsorption device is capable of removing ticagrelor during on-pump cardiac surgery. STAR-T was a North American randomized, double-blind, sham-controlled trial investigating intraoperative ticagrelor removal with this device to reduce perioperative bleeding in cardiac surgery. The International STAR Registry (STAR-R) collects real-world outcomes with antithrombotic drug removal by the same device. Methods: STAR-T randomized patients 1:1 to the device or sham, whereas all STAR-R patients received the device. The device was integrated into the cardiopulmonary bypass (CPB) circuit. Inclusion/exclusion criteria from STAR-T were applied to STAR-R to identify patients on ticagrelor undergoing isolated CABG before washing out. Device-treated patients were pooled and compared to STAR-T controls. Patient-level data were analyzed with a primary endpoint of major bleeding defined as the composite of Universal Definition for Perioperative Bleeding (UDPB ≥ 3) or 24-hr chest tube drainage (CTD) ≥ 1 L. Results: The pooled cohort comprised 153 device-treated patients and 60 controls, with a mean age was 64.4 ± 9.6 years and 84% males. Demographics and baseline characteristics were balanced, except for the time from last ticagrelor dose to CABG, which was significantly shorter in device-treated patients (28.8 ± 16.4 vs. 38.6 ± 14.6 hours, p < 0.001). Operation (4.3 ± 1.3 vs. 4.2 ± 1.2 hours, p = 0.710) and CPB (95.3 ± 35.9 vs. 94 ± 34.4 minutes, p = 0.801) durations were similar. Major bleeding was significantly reduced in device-treated patients compared with controls (16.3% vs. 30.0%, p = 0.02), corresponding to a number needed to treat of seven to prevent a major bleed. Multivariate logistic regression identified age and the use of the device as independent predictors of post-CABG major bleeding. Conclusion: Pooled data from a randomized trial and a real-world registry show that intraoperative ticagrelor removal with a novel device reduces major perioperative bleeding in patients undergoing CABG before completing the recommended washout. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany