The Italian born, French raised Russian came into the race as the joint leader for the British super-team alongside 2019 Tour de France champion, Egan Bernal after a solid display at the recent Tour of the Alps where he was defending champion.
But he lost a bit of time to the other main general classification riders on the first climbing day and then crashed on stage five where he was the only rider to come down after a movement in the peloton forced him off the road.
The 23-year-old looked like he had taken a nasty knock when he got up as he held his back before slowly getting back onto his bike with blood running down his arm.
He also had a tear on the back of his jersey where it looked like his radio was, which would have been very unpleasant to land on.
Immediately it looked like he was not trying to find his way back through the cars to get back to the peloton and his team-mates, waving Jhonatan Narváez away after the former Ecuadorian champion dropped back to help him back.
It was later confirmed in a Tweet by the team that Sivakov has had to abandon the race with an injured shoulder. A major blow for the team for his race aims and Bernal's.
The pace had risen dramatically in the closing 20km after what had been a rather slow-paced day on the flat straight main road towards the finish town of Cattolica.
Sivakov was right up towards the front with his Ineos Grenadiers team-mates but the peloton moved as a rider further up the bunch avoided another rider's wheel. This created a ripple effect down the bunch, pushing Sivakov off the road and down.
The Ineos Grenadiers man finished in last place on the stage with Narváez just ahead of him over 13 minutes down on the winner, Caleb Ewan (Lotto-Soudal).
Other riders who came down, in a separate crash to Sivakov, were second place overall and stage four winner, Joe Dombrowski (UAE Team Emirates), Filippo Fiorelli (Bardiani) who was high in the GC and Mikel Landa (Bahrain Victorious), all in the same crash.
Landa did not finish the stage with wrist and shoulder injuries after hitting the road hard. He was taken to the hospital in an ambulance.
It is not yet known what the injuries for Sivakov are but there it was announced on Eurosport and GCN+'s post-stage show that it could be a possible broken collarbone for the Russian rider.
With the first major mountain stage of the race coming tomorrow on stage six, this is a major blow to several riders ambitions for the overall win at the race.
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