Recommendation 11. We recommend continuation of ASA in all patients with ACS who require CABG surgery (Strong Recommendation; Moderate-Quality Evidence).
Recommendation 12. To minimize the risk of bleeding, for patients with an ACS who are receiving ticagrelor and need semi-urgent CABG, we suggest a minimum interruption of ticagrelor for 48-72 hours before CABG (Weak Recommendation; Low-Quality Evidence) and recommend an ideal interruption period of 5 days before elective CABG (Strong Recommendation; Moderate-Quality Evidence).
Recommendation 13. To minimize the risk of bleeding, for patients with an ACS who are receiving clopidogrel and need semiurgent CABG, we suggest a minimum interruption of clopidogrel for 48-72 hours before CABG (Weak Recommendation; Low-Quality Evidence) and recommend an ideal interruption period of 5 days before elective CABG (Strong Recommendation; Moderate-Quality Evidence).
Recommendation 14. To minimize the risk of bleeding, for patients with an ACS who are receiving prasugrel and need semiurgent CABG, we suggest a minimum interruption of prasugrel for 5 days before CABG (Weak Recommendation; Very Low-Quality Evidence) and recommend an ideal interruption period of 7 days before elective CABG (Strong Recommendation; Moderate-Quality Evidence).
Practical tip. Antiplatelet therapy management in the perioperative period should be based on a balanced assessment of the risks of coronary thrombotic complications vs the risk of perioperative bleeding in discussion with the surgeon, interventional cardiologist, attending physician/cardiologist, and the patient.