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Comparison of Outcomes in Patients Requiring Mechanical Circulatory Support Who Received Cangrelor in Addition to
Trent C Martin1, Brittney E Duewell1, Janelle J Juul1
1Department of Pharmacy, Froedtert Hospital, Milwaukee, WI.
Insights
Cangrelor use with mechanical circulatory support did not increase major bleeding risk in this study. Further research is needed to confirm the safety of cangrelor in these critically ill patients.
Area of Science:
- Cardiology
- Pharmacology
- Critical Care Medicine
Background:
- Mechanical circulatory support (MCS) is crucial for patients with severe cardiovascular conditions.
- Concurrent use of cangrelor, an intravenous P2Y12 inhibitor, with anticoagulants like heparin or bivalirudin in MCS patients requires safety evaluation.
- Understanding bleeding risk is paramount for optimizing antithrombotic therapy in this high-risk population.
Purpose of the Study:
- To assess the safety of cangrelor when administered with heparin or bivalirudin in patients requiring mechanical circulatory support.
- To compare the incidence of major bleeding between MCS patients who received cangrelor and those who did not.
Main Methods:
- Retrospective cohort study at a single tertiary medical center.
- Included adult patients on MCS for acute myocardial infarction or other indications, who underwent percutaneous coronary intervention.
- Compared major bleeding events (using ELSO criteria) in patients receiving cangrelor versus those not receiving cangrelor.
Main Results:
- Sixty-eight patients were analyzed; 29 received cangrelor, and 39 did not.
- Cangrelor was not significantly associated with an increased risk of major bleeding (aHR 1.93, 95% CI 0.61-6.11).
- The confidence interval for the adjusted hazard ratio was wide, indicating uncertainty in the estimate.
Conclusions:
- Cangrelor administration in patients on mechanical circulatory support does not appear to elevate the risk of major bleeding.
- Larger, prospective trials are necessary to definitively establish the safety profile of cangrelor in this patient cohort.
Objectives:
To evaluate the safety of cangrelor administered concurrently with heparin or bivalirudin in patients on mechanical circulatory support.
Design:
A single-center, retrospective cohort study of adult patients consecutively admitted between January 2016 and October 2020.
Setting:
A tertiary medical center.
Participants:
Adult patients admitted to the cardiovascular intensive care unit put on mechanical circulatory support for acute myocardial infarction (AMI) or non-AMI indications. Patients who received cangrelor underwent percutaneous coronary intervention with stenting during the index event or within the last year.
Interventions:
None.
Measurements And Main Results:
The primary outcome was the incidence of major bleeding, defined by the Extracorporeal Life Support Organization criteria, in patients with mechanical circulatory support receiving cangrelor plus anticoagulation with heparin or bivalirudin with or without aspirin versus patients who did not receive cangrelor. Sixty-eight patients were included in the study. Twenty-nine patients received cangrelor, and 39 did not. Cangrelor was not associated with an increase in major bleeding; however, the CI was wide (adjusted hazard ratio 1.93, 95% CI 0.61-6.11; p = 0.262).
Conclusions:
Patients receiving cangrelor did not appear to be at higher risk of major bleeding compared to patients not receiving cangrelor. Larger trials should be conducted to better evaluate the safety of cangrelor in patients with mechanical circulatory support.
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