A Case Report of Cangrelor Bridge Therapy for a Diagnostic Bronchoscopy With Biopsy

Calnan, Matthew W.; Crawford, Alexis N.

doi:10.1177/0897190018795343

Cited by 6 publications

(12 citation statements)

References 19 publications

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“…8 Retrospective studies of cangrelor bridging for NCS report either no bleeding or minor procedural bleeding (Table 4), suggesting that this is a safe approach to perioperative platelet inhibition. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, the BRIDGE trial reported a low incidence of preoperative ischemic events, and retrospective studies of cangrelor bridging for NCS report a low incidence of perioperative MACE (Table 4). 8,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Thus, cangrelor bridging appears to be an effective approach for mitigating the risk of perioperative MACE.…”

Section: Table 4 (Continued)mentioning

confidence: 99%

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Perioperative Antiplatelet Bridging With Cangrelor: A Cohort Study and Narrative Review

Salgia

Gillette

2022

Ann Pharmacother

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Background: In patients who received a cardiac stent, practice guidelines recommend dual antiplatelet therapy (DAPT). However, an urgent procedure may be required necessitating interruption of DAPT. Intravenous cangrelor was previously shown to be an alternative due its short-half life and quick onset/offset. Objective: To determine the safety and effectiveness of cangrelor bridging for patients undergoing invasive procedures in a veteran population. Methods: Retrospective cohort of patients from Michael E. DeBakey VA Medical Center and the VA North Texas Health Care Systems who underwent perioperative cangrelor bridging. The primary outcome was the incidence of bleeding using the Bleeding Academic Research Consortium (BARC) criteria. The secondary outcome was a composite of nonfatal stroke, myocardial infarction (MI), mortality, and unplanned revascularization within 30 days. A narrative review was also performed to summarize cangrelor bridging for noncardiac invasive procedure. Results: There were 41 patients that met the eligibility criteria. Patients were predominantly Caucasian (57.5%) men with a median age of 70 years. The median duration on cangrelor bridging was 2.6 days with 11 and 30 patients undergoing cardiac and noncardiac invasive procedures, respectively. Nine patients (22%) had a bleeding event of which 8 were minor. One was severe due to significant iliopsoas hematoma following drain placement. All bleeding events occurred postoperatively except for 2 perioperative events that occurred during orthopedic procedures. Ischemic events up to 30 days occurred in 3 patients (7.3%) which consisted of 1 (2.4%) nonfatal MI requiring revascularization and 2 (4.9%) deaths, 1 of which was sudden cardiac. Conclusion and Relevance: This study suggests that cangrelor bridging may be a reasonable alternative to holding oral P2Y12 inhibitors in patients requiring interruption of antiplatelet therapy for an urgent surgery/invasive procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Table 4 (Continued)mentioning

confidence: 99%

Perioperative Antiplatelet Bridging With Cangrelor: A Cohort Study and Narrative Review

Salgia

Gillette

2022

Ann Pharmacother

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“…22 To date, there is no randomized trial of bridging with cangrelor in NCS, and limited observational experience are available with heterogenous prescribing and monitoring practices, which may contribute to suboptimal outcomes. [10][11][12][13][14][15][16] Likewise, data on bridging use of short-acting GPIs are heterogeneous as well with regard to type of surgery, inclusion criteria, time windows between stent implantation or ACS and surgery, and antiplatelet strategies during the perioperative period which may partly explain the reported variability in success rates. 37 Despite the inclusion of a similar miscellaneous of surgical procedures, we believed that the strength of our study is a standardize case by case approach evaluation to weight the ischemic and bleeding risk and the use of a bridging protocol with a close postoperative monitoring which could have had a positive impact on our study findings.…”

Section: Discussionmentioning

confidence: 99%

“…9 However, there is limited reported data on the use of cangrelor among patients undergoing noncardiac surgery (NCS). [10][11][12][13][14][15][16] On this background, we report the results of a prospective, multicenter registry describing realworld experience of a prespecified bridging protocol using cangrelor conducted in patients referred to nondeferrable intermediate to high bleeding risk surgery requiring withdrawal of DAPT.…”

Section: Introductionmentioning

confidence: 99%

Antiplatelet Therapy with Cangrelor in Patients Undergoing Surgery after Coronary Stent Implantation: A Real-World Bridging Protocol Experience

Rossini

Masiero

Fruttero

et al. 2020

TH Open

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Objective The aim of the study is to describe the real-world use of the P2Y12 inhibitor cangrelor as a bridging strategy in patients at high thrombotic risk after percutaneous coronary intervention (PCI) and referred to surgery requiring perioperative withdrawal of dual antiplatelet therapy (DAPT). Materials and Methods We collected data from nine Italian centers on patients with previous PCI who were still on DAPT and undergoing nondeferrable surgery requiring DAPT discontinuation. A perioperative standardized bridging protocol with cangrelor was used. Results Between December 2017 and April 2019, 24 patients (mean age 72 years; male 79%) were enrolled. All patients were at high thrombotic risk after PCI and required nondeferrable intermediate to high bleeding risk surgery requiring DAPT discontinuation (4.6 ± 1.7 days). Cangrelor infusion was started at a bridging dose (0.75 µg/kg/min) 3 days before planned surgery and was discontinued 6.6 ± 1.5 hours prior to surgical incision. In 55% of patients, cangrelor was resumed at 9 ± 6 hours following surgery for a mean of 39 ± 38 hours. One cardiac death was reported after 3 hours of cangrelor discontinuation prior to surgery. No ischemic outcomes occurred after surgery and up to 30-days follow-up. The mean hemoglobin drop was <2 g/dL; nine patients received blood transfusions consistent with the type of surgery, but no life-threatening or fatal bleeding occurred. Conclusion Perioperative bridging therapy with cangrelor is a feasible approach for stented patients at high thrombotic risk and referred to surgery requiring DAPT discontinuation. Larger studies are warranted to support the safety of this strategy.

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“…Additionally, case reports of successful cangrelor bridging describe variable dosing (range 0.25-4 µg/kg/min) and inconsistent use of PRUs to monitor efficacy of the drug. [66][67][68][69] Therefore, the efficacy of cangrelor at 0.75 µg/kg/min is based on a surrogate marker in a low-risk patient population, and the appropriate bridging dose of cangrelor remains debatable.…”

Section: Safety and Efficacy Of IV Antiplatelet Agentsmentioning

confidence: 99%

Perioperative Bridging With Glycoprotein IIb/IIIa Inhibitors Versus Cangrelor: Balancing Efficacy and Safety

2019

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A Case Report of Cangrelor Bridge Therapy for a Diagnostic Bronchoscopy With Biopsy

Cited by 6 publications

References 19 publications

Perioperative Antiplatelet Bridging With Cangrelor: A Cohort Study and Narrative Review

Perioperative Antiplatelet Bridging With Cangrelor: A Cohort Study and Narrative Review

Antiplatelet Therapy with Cangrelor in Patients Undergoing Surgery after Coronary Stent Implantation: A Real-World Bridging Protocol Experience

Perioperative Bridging With Glycoprotein IIb/IIIa Inhibitors Versus Cangrelor: Balancing Efficacy and Safety

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