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

Michael S. Firstenberg, Cornelius M. Dyke, Dominick J. Angiolillo, Chandrashekar Ramaiahm, Matthew Price, Miroslav Brtko, Ian Welsby, Harish Chandna, David R. Holmes, Michele Voeltz, Pradyumna Tummala, Martin Hutyra, Steven V. Manoukian, Jayne Prats, Meredith Todd, Tiepu Liu, Nicholas Chronos, Markus Dietrich, Gilles Montalescot, Louis A. CannonEric J. Topol

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

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 P2Y 12 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 P2Y 12 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 clini cal 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 post-operative 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.

Original languageEnglish (US)
Pages (from-to)E60-E69
JournalHeart Surgery Forum
Volume16
Issue number2
DOIs
StatePublished - Apr 2013

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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