“Tailored” antiplatelet bridging therapy with cangrelor: moving toward personalized medicine

Valenti, Renato; Muraca, Iacopo; Marcucci, Rossella; Ciatti, Francesca; Berteotti, Martina; Gori, Anna Maria; Carrabba, Nazario; Migliorini, Angela; Marchionni, Niccolò; Valgimigli, Marco

doi:10.1080/09537104.2021.1983162

Cited by 7 publications

(8 citation statements)

References 23 publications

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“…In the overall population, thrombotic events were reported in 6 patients (35%). While cangrelor dose adjustment based upon PRU was used in the study by Katz et al 6 and other studies, [22][23][24] it remains unclear if PRU-guided dosing with cangrelor provides a reduction in bleeding events, while maintaining similar efficacy versus empiric dosing at 0.75 mcg/kg/min. Bleeding event rates in our study for patients treated with cangrelor were comparable to these previous studies with 36.8% for major bleeding and 73.7% for overall bleeding.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical outcomes with cangrelor plus aspirin versus oral dual antiplatelet therapy in patients supported with venoarterial extracorporeal membrane oxygenation

et al. 2023

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BackgroundPatients with refractory cardiogenic shock from an acute myocardial infarction may receive percutaneous coronary intervention (PCI) and require the use of venoarterial extracorporeal membrane oxygenation (VA–ECMO). The purpose of this study was to compare bleeding and thrombotic events in patients treated with cangrelor plus aspirin versus oral dual antiplatelet therapy (DAPT) while supported with VA–ECMO.MethodsWe conducted a retrospective review of patients who received PCI, were supported with VA–ECMO, and were treated with either cangrelor plus aspirin or oral DAPT from February 2016 through May 2021 at Allegheny General Hospital. The primary objective was the incidence of major bleeding, defined as Bleeding Academic Research Consortium (BARC) type 3 or greater. The incidence of thrombotic events was a secondary objective.ResultsThirty‐seven patients were included, 19 in the cangrelor plus aspirin group, and 18 in the oral DAPT group. All the patients in the cangrelor group received a dose of 0.75 mcg/kg/min. Major bleeding occurred in 7 patients (36.8%) in the cangrelor group compared to 7 patients (38.9%) in the oral DAPT group (p = 0.90). No patient developed stent thrombosis. Two patients (10.5%) in the cangrelor group had a thrombotic event versus 3 patients (16.7%) in the oral DAPT group (p = 0.66).ConclusionsBleeding and thrombotic events were comparable between patients receiving cangrelor plus aspirin versus oral DAPT while on VA–ECMO.

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Section: Discussionmentioning

confidence: 99%

Comparison of clinical outcomes with cangrelor plus aspirin versus oral dual antiplatelet therapy in patients supported with venoarterial extracorporeal membrane oxygenation

et al. 2023

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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%

“…Patient selection and bridging practices vary somewhat across studies, though the literature consistently reports a low incidence of perioperative bleeding and ischemic events. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Although an international consensus statement provides guidance on using cangrelor for off-label perioperative bridging, there remain areas of uncertainty. 10 It is not fully known whether the VerifyNow PRUTest of platelet reactivity can be used to guide timing of cangrelor after oral washout.…”

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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“…Looking at the currently available data, there is no study examining the prevalence of cangrelor HTPR in patients with acute coronary syndrome, no study describing this phenomenon or clinical case report describing a case of ischemic adverse post-PCI event related to failure of cangrelor therapy. Moreover, cangrelor seems to be a promising agent for treatment (overcoming) prasugrel HTPR [ 79 , 80 ] or to bridge the gap until optimal platelet inhibition with ticagrelor is achieved [ 81 ]. Nevertheless, cangrelor has been approved for clinical use in patients undergoing PCI relatively recently; thus, it might be possible that the phenomenon of cangrelor HTPR just awaits its description.…”

Section: Cangrelor Resistance In Patients With Acsmentioning

confidence: 99%

Resistance on the Latest Oral and Intravenous P2Y12 ADP Receptor Blockers in Patients with Acute Coronary Syndromes: Fact or Myth?

Blaško

Samoš

Bolek

et al. 2022

JCM

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Novel P2Y12 ADP receptor blockers (ADPRB) should be preferred in dual-antiplatelet therapy in patients with acute coronary syndrome. Nevertheless, there are still patients who do not respond optimally to novel ADP receptor blocker therapy, and this nonoptimal response (so-called “high on-treatment platelet reactivity” or “resistance”) could be connected with increased risk of adverse ischemic events, such as myocardial re-infarction, target lesion failure and stent thrombosis. In addition, several risk factors have been proposed as factors associated with the phenomenon of inadequate response on novel ADPRB. These include obesity, multivessel coronary artery disease, high pre-treatment platelet reactivity and impaired metabolic status for prasugrel, as well as elderly, concomitant therapy with beta-blockers, morphine and platelet count for ticagrelor. There is no literature report describing nonoptimal therapeutic response on cangrelor, and cangrelor therapy seems to be a possible approach for overcoming HTPR on prasugrel and ticagrelor. However, the optimal therapeutic management of “resistance” on novel ADPRB is not clear and this issue requires further research. This narrative review article discusses the phenomenon of high on-treatment platelet reactivity on novel ADPRB, its importance in clinical practice and approaches for its therapeutic overcoming.

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“Tailored” antiplatelet bridging therapy with cangrelor: moving toward personalized medicine

Cited by 7 publications

References 23 publications

Comparison of clinical outcomes with cangrelor plus aspirin versus oral dual antiplatelet therapy in patients supported with venoarterial extracorporeal membrane oxygenation

Comparison of clinical outcomes with cangrelor plus aspirin versus oral dual antiplatelet therapy in patients supported with venoarterial extracorporeal membrane oxygenation

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

Resistance on the Latest Oral and Intravenous P2Y12 ADP Receptor Blockers in Patients with Acute Coronary Syndromes: Fact or Myth?

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