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Long-Term Cangrelor Administration in Neurology Intensive Care: A Case Series

Olivier Duranteau1,2, Lamine Abdennour1, Mehdi Drir1

  • 1From the Neuro-Intensive Care Unit, Department of Anesthesiology and Intensive Care, Pitié-Salpêtrière Hospital, Paris, France.

A&A Practice
|January 27, 2023
PubMed

Insights

Cangrelor, a P2Y12 inhibitor, was safely administered for over one month in neurosurgical patients at high risk for revision surgery. This extended use showed no major bleeding events, suggesting its potential in complex neurovascular cases.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Cangrelor is a P2Y12 inhibitor with rapid onset/offset, typically used for short durations.
  • Limited data exists on long-term cangrelor administration.
  • Patients requiring revision neurosurgery often face high risks.

Purpose of the Study:

  • To evaluate the safety and feasibility of prolonged cangrelor administration (>1 month) in neurocritical care settings.
  • To assess the occurrence of hemorrhagic or ischemic events during extended cangrelor use in high-risk neurosurgical patients.

Main Methods:

  • Retrospective case series of 5 patients receiving cangrelor for >1 month in a neurosurgical ICU.
  • Monitoring for hemorrhagic and ischemic events throughout the treatment period.
  • Analysis of cangrelor's safety profile during interruptions for surgical procedures.

Main Results:

  • No hemorrhagic events were observed in any of the 5 patients during prolonged cangrelor therapy.
  • One transient ischemic event occurred, specifically during the transition from cangrelor to ticagrelor.
  • Cangrelor was successfully used in patients with a high likelihood of requiring emergency revision surgery.

Conclusions:

  • Extended cangrelor administration (>1 month) appears safe and feasible in select neurocritical care patients.
  • Cangrelor may be a viable therapeutic option for patients with a high risk of requiring revision neurosurgery post-intracranial stenting.
  • Careful monitoring and transition strategies are important when managing long-term cangrelor therapy.

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