Foundational Insights and Costs of Care Associated With Perioperative Ticagrelor Management for Patients Undergoing Coronary Artery Bypass Graft Surgery: A Medical Chart Audit Review
Author(s)
Ralph J. Riello, III, PharmD1, Christina England, MPH2, Aishwarya Kulkarni, MS3, Vijay Abilash, MS3, Bhagyashree Oak, PhD3, Matthew O'Hara, MBA3, John McKenney, B.A.SC2, Jackie Evans-Shields, PharmD2, John Fanikos, RPh, MBA4.
1Clinical & Translational Research Accelerator, Yale University School of Medicine, New Haven, CT, USA, 2SERB Pharmaceuticals, Conshohocken, PA, USA, 3Trinity Life Sciences, Waltham, MA, USA, 4North American Thrombosis Forum, Vasculearn Network, Brookline, MA, USA.
1Clinical & Translational Research Accelerator, Yale University School of Medicine, New Haven, CT, USA, 2SERB Pharmaceuticals, Conshohocken, PA, USA, 3Trinity Life Sciences, Waltham, MA, USA, 4North American Thrombosis Forum, Vasculearn Network, Brookline, MA, USA.
Presentation Documents
OBJECTIVES: Characterize the patient journey, including clinical outcomes, healthcare resource utilization (HCRU), and cost of care for ticagrelor-treated patients undergoing coronary artery bypass graft (CABG) surgery after antiplatelet washout.
METHODS: We conducted an IRB-exempt, medical record review between November-December 2024. Cardiac/cardiothoracic surgeons/interventional cardiologists who annually manage ≥5 patients receiving ticagrelor undergoing CABG completed an electronic questionnaire to abstract data on patient demographics, incidence of complications, pharmacy, blood product use and HCRU. Descriptive analyses were conducted for three phases of care: pre-surgery, intraoperative, and post-procedure. Costs were aggregated across multiple sources.
RESULTS: Sixty-six physicians provided 228 patient encounters of which 195 underwent ticagrelor washout. Patients experienced bleeding pre- (17%) and post-CABG (11%). During antiplatelet washout, common complications included hospital-acquired infection (HAIs, 3%) and mechanical ventilation (3%). The average cost per patient during washout, including observation, complications, and blood products cost, was $5,757. 27% of patients were admitted to the intensive care unit (ICU) perioperatively, with an average length of stay (LOS) of 45 days in the Surgical ICU (SICU) or 17 days in the Cardiac ICU (CICU). 9% of patients had non-ICU stays, with an average LOS of 4.4 days. The average pre-CABG hospital stay cost per patient was $17,167. Post-procedure, common complications were mechanical ventilation (8%) and HAIs (3%). ICU stays were an average LOS of 7 days in SICU and 10.2 days in CICU. The average post-procedure cost per patient, including complications, blood product, and hospital stay costs, was $12,000.
CONCLUSIONS: Perioperative ticagrelor management for patients undergoing CABG is expensive, with high HCRU and corresponding costs, particularly prior to surgery. This study highlights the need for a rapid ticagrelor reversal agent to reduce the clinical and economic burden of antiplatelet washout among patients undergoing CABG surgery.
METHODS: We conducted an IRB-exempt, medical record review between November-December 2024. Cardiac/cardiothoracic surgeons/interventional cardiologists who annually manage ≥5 patients receiving ticagrelor undergoing CABG completed an electronic questionnaire to abstract data on patient demographics, incidence of complications, pharmacy, blood product use and HCRU. Descriptive analyses were conducted for three phases of care: pre-surgery, intraoperative, and post-procedure. Costs were aggregated across multiple sources.
RESULTS: Sixty-six physicians provided 228 patient encounters of which 195 underwent ticagrelor washout. Patients experienced bleeding pre- (17%) and post-CABG (11%). During antiplatelet washout, common complications included hospital-acquired infection (HAIs, 3%) and mechanical ventilation (3%). The average cost per patient during washout, including observation, complications, and blood products cost, was $5,757. 27% of patients were admitted to the intensive care unit (ICU) perioperatively, with an average length of stay (LOS) of 45 days in the Surgical ICU (SICU) or 17 days in the Cardiac ICU (CICU). 9% of patients had non-ICU stays, with an average LOS of 4.4 days. The average pre-CABG hospital stay cost per patient was $17,167. Post-procedure, common complications were mechanical ventilation (8%) and HAIs (3%). ICU stays were an average LOS of 7 days in SICU and 10.2 days in CICU. The average post-procedure cost per patient, including complications, blood product, and hospital stay costs, was $12,000.
CONCLUSIONS: Perioperative ticagrelor management for patients undergoing CABG is expensive, with high HCRU and corresponding costs, particularly prior to surgery. This study highlights the need for a rapid ticagrelor reversal agent to reduce the clinical and economic burden of antiplatelet washout among patients undergoing CABG surgery.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
SA75
Topic
Study Approaches
Disease
STA: Multiple/Other Specialized Treatments