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Published on: June 12, 2021
Clinical Use of Cangrelor After Percutaneous Coronary Intervention in Patients Requiring Mechanical Circulatory
Alyson Katz1, Tyler C Lewis1, Serena Arnouk1
1NYU Langone Health, New York, NY, USA.
Insights
Cangrelor use in patients needing mechanical circulatory support after percutaneous coronary intervention was associated with significant bleeding events. Lower cangrelor doses may reduce complications, warranting further investigation in larger studies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Mechanical circulatory support (MCS) is crucial for patients with cardiogenic shock post-percutaneous coronary intervention (PCI).
- Concurrent use of cangrelor and anticoagulation for MCS increases bleeding risk.
Purpose of the Study:
- To evaluate complications and outcomes of cangrelor use in patients on MCS after PCI.
- To identify potential associations between cangrelor dosing and adverse events.
Main Methods:
- Retrospective, single-center case series of 17 patients receiving cangrelor during MCS.
- Data collected on device support (Impella, VA ECMO), antithrombotic therapy, cangrelor dosing, and bleeding events.
Main Results:
- 59% of patients experienced bleeding events, primarily at cannulation sites and gastrointestinal tract.
- 82% of patients survived the MCS course; no in-stent thrombosis occurred.
- Bleeding complications were predominantly major (70%).
Conclusions:
- Cangrelor use in this high-risk population is associated with considerable bleeding.
- Doses below 0.75 µg/kg/min may be safer and warrant further study.
- Larger trials are needed to confirm optimal cangrelor dosing strategies.
Background:
Patients with cardiogenic shock after percutaneous coronary intervention (PCI) may require mechanical circulatory support (MCS). The combination of dual antiplatelet therapy with cangrelor and continuous anticoagulation required for MCS may increase the risk of bleeding.
Objective:
The objective of the study is to describe the complications and outcomes of patients who received cangrelor during MCS following PCI.
Methods:
This is a single-center, retrospective, observational case series of 17 patients who received cangrelor while on MCS from June 2017 to September 2019.
Results:
In a case series of 17 patients, 8 patients (47%) were supported with an Impella device and 4 patients (24%) with venoarterial (VA) extracorporeal membrane oxygenation (ECMO); 5 required (29%) concomitant VA ECMO and Impella support in the setting of cardiogenic shock. All patients received triple antithrombotic therapy with aspirin, heparin, and cangrelor. Cangrelor was commonly initiated at a median dose of 0.75 (range 0.5-4) µg/kg/min. Cangrelor dose adjustments included changes in increments up to 0.25 µg/kg/min with review of P2Y12 levels. A total of 10 patients (59%) experienced a bleeding event, most commonly located at the peripheral cannulation site (40%) and in the gastrointestinal tract (30%). Seven (70%) and 3 (30%) of the bleeding complications were classified as major and minor, respectively. No patient developed in-stent thrombosis during the hospitalization; 14 (82%) patients survived their MCS course.
Conclusion And Relevance:
This case series suggests that cangrelor doses less than 0.75 µg/kg/min may be beneficial. Larger studies should evaluate alternative dosing regimens.
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