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Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery.

Publication ,  Journal Article
Firstenberg, MS; Dyke, CM; Angiolillo, DJ; Ramaiahm, C; Price, M; Brtko, M; Welsby, I; Chandna, H; Holmes, DR; Voeltz, M; Tummala, P; Prats, J ...
Published in: Heart Surg Forum
April 2013

OBJECTIVE: Oral P2Y₁₂ platelet receptor inhibitors are a cornerstone of reducing complications in patients with acute coronary syndromes or coronary stents. Guidelines advocate discontinuing treatment with P2Y₁₂ platelet receptor inhibitors before surgery. Cangrelor, a short-acting, reversible, intravenously administered P2Y₁₂ platelet inhibitor is effective in achieving appropriate platelet inhibition in patients who are awaiting coronary artery bypass grafting (CABG) and require P2Y₁₂ inhibition. The objective of this study was to assess the effects of preoperative cangrelor on the incidence of perioperative complications, which are currently unknown. METHODS: Patients (n = 210) requiring preoperative clinical administration of thienopyridine therapy were randomized in a multicenter, double-blinded study to receive cangrelor or placebo while awaiting CABG after discontinuation of the thienopyridine. Optimal platelet reactivity, which was defined as <240 P2Y₁₂ platelet reaction units, was measured with serial point-of-care testing (VerifyNow). Pre- and postoperative outcomes, bleeding values, and transfusion rates were compared. To quantify potential risk factors for bleeding, we developed a multivariate logistic model. RESULTS: The differences between the groups in bleeding and perioperative transfusion rates were not significantly different. The rate of CABG-related bleeding was 11.8% (12/102) in cangrelor-treated patients and 10.4% (10/96) in the placebo group (P = .763). Transfusion rates for the groups were similar. Serious postoperative adverse events for the cangrelor and placebo groups were 7.8% (8/102) and 5.2% (5/96), respectively (P = .454). CONCLUSIONS: Compared with placebo, bridging patients with cangrelor prior to CABG effectively maintains platelet inhibition without increasing post-CABG complications, including bleeding and the need for transfusions. These data suggest cangrelor treatment is a potential strategy for bridging patients requiring P2Y₁₂ receptor inhibition while they await surgery.

Duke Scholars

Published In

Heart Surg Forum

DOI

EISSN

1522-6662

Publication Date

April 2013

Volume

16

Issue

2

Start / End Page

E60 / E69

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk Assessment
  • Pyridines
  • Purinergic P2Y Receptor Antagonists
  • Prevalence
  • Premedication
  • Postoperative Hemorrhage
  • Platelet Aggregation Inhibitors
  • Placebo Effect
 

Citation

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Firstenberg, M. S., Dyke, C. M., Angiolillo, D. J., Ramaiahm, C., Price, M., Brtko, M., … Topo, E. J. (2013). Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery. Heart Surg Forum, 16(2), E60–E69. https://doi.org/10.1532/HSF98.20121103
Firstenberg, Michael S., Cornelius M. Dyke, Dominick J. Angiolillo, Chandrashekar Ramaiahm, Matthew Price, Miroslav Brtko, Ian Welsby, et al. “Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery.Heart Surg Forum 16, no. 2 (April 2013): E60–69. https://doi.org/10.1532/HSF98.20121103.
Firstenberg MS, Dyke CM, Angiolillo DJ, Ramaiahm C, Price M, Brtko M, et al. Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery. Heart Surg Forum. 2013 Apr;16(2):E60–9.
Firstenberg, Michael S., et al. “Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery.Heart Surg Forum, vol. 16, no. 2, Apr. 2013, pp. E60–69. Pubmed, doi:10.1532/HSF98.20121103.
Firstenberg MS, Dyke CM, Angiolillo DJ, Ramaiahm C, Price M, Brtko M, Welsby I, Chandna H, Holmes DR, Voeltz M, Tummala P, Hutyra M, Manoukian SV, Prats J, Todd M, Liu T, Chronos N, Dietrich M, Montalescot G, Cannon LA, Topo EJ. Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery. Heart Surg Forum. 2013 Apr;16(2):E60–E69.

Published In

Heart Surg Forum

DOI

EISSN

1522-6662

Publication Date

April 2013

Volume

16

Issue

2

Start / End Page

E60 / E69

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk Assessment
  • Pyridines
  • Purinergic P2Y Receptor Antagonists
  • Prevalence
  • Premedication
  • Postoperative Hemorrhage
  • Platelet Aggregation Inhibitors
  • Placebo Effect