Faculty, Staff and Student Publications

Language

English

Publication Date

3-22-2026

Journal

American Journal of Case Reports

DOI

10.12659/AJCR.950336

PMID

41865238

PMCID

PMC13019788

PubMedCentral® Posted Date

3-22-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Case series

Patients: Male, 52-year-old Male, 66-year-old

Final Diagnosis: Uncontrolled bleeding following ticagrelor associated with cardiac surgery

Symptoms: Bleeding

Clinical Procedure: —

Specialty: Cardiology Critical Care Medicine Pathology

Objective: Unusual clinical course

Background

Acute coronary syndrome is the most common cause of death in the United States. Successful intervention often requires a multi-therapeutic approach, including percutaneous coronary intervention (PCI) and antiplatelet agents such as ticagrelor. However, the use of antiplatelet agents can cause life-threatening bleeding, particularly during emergency procedures. Therapeutic plasma exchange (TPE) is a procedure that selectively removes the patient’s plasma to eliminate harmful substances. Here, we present 2 cases of novel TPE implementation in the setting of uncontrolled ticagrelor-induced bleeding.

Case Reports

Our first case was a 52-year-old man who presented with ST-elevation myocardial infarction. He underwent emergency percutaneous coronary intervention and was started on dual antiplatelet therapy (aspirin 81 mg/day, and ticagrelor 90 mg twice daily). A post-infarction ventricular septal defect required emergency surgical repair. After the surgery, uncontrolled bleeding persisted despite all conventional treatment methods. Following TPE, the bleeding was controlled, hemostasis was achieved, and platelet function was increased within days. Our second case was a 66-year-old man who received single doses of ticagrelor (180 mg) and eptifibatide (180 mcg/kg) during an attempted PCI. After complication by left main coronary artery dissection, emergency 2-vessel coronary artery bypass surgery was performed. In the immediate postoperative period, TPE was performed for persistent uncontrolled bleeding. Platelet reactivity increased immediately following the procedure; bleeding was stabilized, and no further blood products were required after postoperative day 1.

Conclusions

TPE may be an effective novel option for emergency removal of circulating ticagrelor in refractory bleeding cases.

Keywords

Humans, Male, Ticagrelor, Middle Aged, Platelet Aggregation Inhibitors, Aged, Plasma Exchange, Percutaneous Coronary Intervention, Hemorrhage, ST Elevation Myocardial Infarction

Published Open-Access

yes

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