Cangrelor helps maintain platelet inhibition before CABG
MedWire News: Cangrelor leads to an increased rate of platelet inhibition maintenance among patients who discontinue thienopyridine therapy before cardiac surgery, say researchers.
"Cangrelor achieved and maintained target levels of platelet inhibition known to be associated with a low risk of thrombotic events compared with placebo, without a significant excess in bleeding complications," report Eric Topol (Scripps Translational Science Institute, La Jolla, California, USA) and co-authors in JAMA.
They conducted a randomized, double-blind, placebo-controlled trial involving 210 patients who were awaiting coronary artery bypass graft (CABG) surgery and had an acute coronary syndrome (ACS) or had been treated with a coronary stent and were receiving a thienopyridine.
The first part of the trial, an open-label dose-finding phase involving 11 participants, determined an optimal cangrelor dose of 0.75 µg/kg per minute. In the second phase of the trial, all patients were randomly allocated to receive bridging treatment with either cangrelor, a nonthienopyridine adenosine triphosphate analog, or placebo.
Cangrelor was administered after thienopyridine therapy was discontinued and was continued throughout the preoperative period up to 1-6 hours before surgical incision during CABG surgery.
A significantly higher proportion of patients treated with cangrelor had low levels of platelet reactivity (<240 P2Y12 reaction units) throughout the entire treatment period compared with placebo, at 98.8% versus 19.0% (p<0.001).
The effect of cangrelor was not attenuated after adjusting for expected number of days before surgery and duration of infusion.
Excessive CABG surgery-related bleeding occurred in a total of 22 patients and was not significantly different between patients who received cangrelor or placebo.
"Bridging with a prolonged infusion of cangrelor did not increase major bleeding prior to surgery, as defined according to several established classifications," report the authors.
They conclude: "Our data support the hypothesis that intravenous cangrelor is a feasible management strategy in patients waiting for cardiac surgery who require prolonged platelet P2Y12 inhibition after thienopyridine discontinuation."
MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Piriya Mahendra