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Cangrelor Bridge Therapy for Gastroduodenal Biopsy
William D Cahoon1,2, Allison K Oswalt1,2, Kerry E Francis1,2
11 Department of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA.
Insights
Dual antiplatelet therapy (DAPT) is crucial for preventing cardiac events after stenting. Cangrelor offers a potential bridging option for patients needing temporary DAPT interruption, balancing ischemic and bleeding risks.
Area of Science:
- Cardiology
- Pharmacology
- Gastroenterology
Background:
- Dual antiplatelet therapy (DAPT) is essential for secondary prevention in acute coronary syndromes and after coronary stent placement.
- Premature DAPT cessation increases risks of cardiac ischemic events and mortality.
- Bridging therapy is needed for urgent procedures but lacks FDA-approved options.
Observation:
- A patient with a history of gastrointestinal bleeding was on DAPT for a drug-eluting stent.
- The patient required a gastroduodenal biopsy, necessitating a temporary interruption of DAPT.
- Cangrelor was administered as an antiplatelet bridge therapy before the procedure.
Findings:
- Cangrelor served as a bridge therapy in a patient with a history of gastrointestinal bleeding on DAPT.
- This case highlights a potential strategy for managing DAPT interruption in high-risk patients.
Implications:
- Cangrelor may be a viable option for antiplatelet bridging therapy in specific clinical scenarios.
- Further research is needed to establish guidelines for cangrelor use in DAPT bridging.
- Balancing ischemic and bleeding risks remains critical when managing DAPT interruption.
Abstract:
Dual antiplatelet therapy (DAPT) is the key for secondary prevention of acute coronary syndromes and percutaneous coronary intervention with stent placement. Premature discontinuation of DAPT can result in an increase in cardiac ischemic events and death. If early interruption of DAPT for urgent procedures or surgery is necessary, then ischemic and bleed risks must be balanced with bridging therapy. To date, no medications have a Food and Drug Administration indication for antiplatelet bridge therapy. We present a case of a woman with a history of gastrointestinal bleeding on DAPT for a drug-eluting stent who received cangrelor as bridge therapy prior to gastroduodenal biopsy.
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