Intravenous cangrelor as a peri-procedural bridge with applied uses in ischemic events

Abstract

Cangrelor is a relatively new antiplatelet drug that has been approved for use as an adjunct therapy to percutaneous coronary intervention (PCI) to decrease peri-procedural myocardial infarction (MI), coronary revascularization, and stent thrombosis. Cangrelor is an adenosine triphosphate analogue with a pharmacokinetic mechanism based on a reversible, dose-dependent inhibition adenosine diphosphate (ADP)induced platelet aggregation. This drug has lately been in the spotlight as a possible bridge therapy for antiplatelet medication prior to cardiac and non-cardiac surgeries. Platelet function is usually restored within sixty minutes of cessation of therapy, thereby decreasing the risk of bleeding while providing adequate preprocedural coverage to reduce ischemic events. This manuscript reviews the literature on cangrelor and summarizes its role as a peri-procedural bridge.

Use of Cangrelor in Cervical and Intracranial Stenting for the Treatment of Acute Ischemic Stroke: A “Real Life” Single-Center Experience

“…Thus, cangrelor might be a valuable treatment option also as a bridging strategy (also at the low 0.75-mg/kg/min dose), as recently reported. 18 Indeed, in a case series recently reported by Godier et al 19 on patients undergoing an unplanned operation after intracranial stent placement, the bridging protocol succeeded in achieving and maintaining platelet inhibition during DAPT discontinuation, with a return to baseline platelet function within 1 hour after cangrelor withdrawal.…”

Antiplatelet Therapy in Atherothrombotic Diseases: Similarities and Differences Across Guidelines

“…Many ongoing clinical trials will provide further insights into the comparative role of cangrelor and oral P2Y 12 receptor antagonists (particularly ticagrelor and prasugrel) in the context of ACS patients. Cangrelor could also be an interesting perioperative bridging strategy in high thrombotic risk patients (typically stent implanted within the last 4 weeks) who need urgent high bleeding risk surgery ( Bhattad et al, 2019 ).…”

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

“…Moreover, this data might help to identify the patient population that would receive maximum benefit from bridging antiplatelet therapy, determine optimal administration strategy, monitoring therapy, and management of adverse events to delineate large prospective studies which are required in such challenging setting. 41 …”