Cangrelor in a challenging scenario of concomitant ischaemic stroke, pulmonary embolism, and ST-elevation myocardial...

Area of Science:

• Cardiology
• Neurology
• Pharmacology

Background:

• Antithrombotic therapy is challenging in acute patients with concurrent high ischemic and bleeding risks.
• Balancing anticoagulation and antiplatelet strategies is critical for patient outcomes.

Observation:

• A 48-year-old male presented with ischemic stroke, subsequently developing pulmonary embolism (PE) and ST-elevation myocardial infarction (STEMI).
• The patient exhibited high bleeding risks (anemia, active malignancy, stroke) and high ischemic risks (stroke, PE, STEMI).

Findings:

• A prolonged cangrelor infusion at a reduced dosage (0.75 μg/kg/min), combined with aspirin and enoxaparin, was administered.
• This triple antithrombotic approach proved effective and safe in managing the patient's complex cardiovascular and cerebrovascular conditions.

Implications:

• Prolonged, reduced-dose cangrelor bridging may be a viable strategy for high-risk patients needing P2Y12 inhibition.
• This case highlights a potential therapeutic option for complex antithrombotic management in critically ill patients.