Lower bleeding risk with cangrelor versus clopidogrel–GPIs
medwireNews: Cangrelor is associated with a reduced risk for bleeding compared with clopidogrel plus routinely used glycoprotein IIb/IIIa inhibitors (GPIs) in patients undergoing percutaneous coronary intervention (PCI), results of a pooled analysis suggest.
“Unfortunately, the antiplatelet effects of GPIs last long after cessation of infusion, contributing to an excess in significant bleeding, an end point that has consistently been linked to adverse clinical course,” write Deepak Bhatt (Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts, USA) and colleagues in JAMA Cardiology.
“Cangrelor may offer an alternative potent, parenteral strategy to glycoprotein IIb/IIIa inhibitors with a favorable bleeding profile,” they add.
In an analysis of matched patient data from the CHAMPION trials, the primary efficacy endpoint – a composite of all-cause mortality, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours – occurred in 2.6% of 1021 patients receiving cangrelor alone versus 3.3% of 1021 receiving clopidogrel plus GPIs, a nonsignificant difference (odds ratio [OR]=0.79).
However, the authors observed significantly lower rates of TIMI-defined major or minor bleeding and ACUITY-defined major bleeding in the cangrelor group compared with the clopidogrel–GPI group, with corresponding rates of 0.7% versus 2.4% (OR=0.29) and 3.6% versus 5.8% (OR=0.61).
Although not statistically significant, there were lower rates of GUSTO-defined severe/life-threatening bleeding (0.3 vs 0.7%) and moderate or severe/life-threatening bleeding (1.2 vs 2.3%) among patients receiving cangrelor.
The three phase III CHAMPION trials “collectively demonstrated that cangrelor reduces ischemic complications up to 30 days following PCI compared with clopidogrel or placebo” without increasing the risk for severe bleeding, write the researchers. They explain that these results “formed the basis for the recent approval of cangrelor for use in elective or urgent PCI in the United States and Europe.”
In the present analysis of individual patient-level data, the team compared efficacy and bleeding risk in patients assigned to receive cangrelor who were not receiving GPIs in the CHAMPION trials versus those assigned to clopidogrel who were receiving routine GPIs.
Because more than three-quarters of patients in the matched analysis presented with acute coronary syndromes, the results “primarily reflect this experience and inform, to a lesser extent, stable coronary artery disease,” say Bhatt and colleagues.
Although the authors highlight the limitations associated with nonrandomized exploratory analyses, they note that there are “no randomized data available” that directly compare cangrelor with GPIs.
And they conclude: “Comparative effectiveness and cost-effectiveness data on fast-acting, potent antiplatelet regimens are required.”
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