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Bridging Antiplatelet Therapy With Cangrelor in Spinal Cord Stimulator Trial and Implant for Patient With Refractory
Marshall Yuan1, Angie Kuang2, David Hao3
1Robert Wood Johnson Medical School, Piscataway, NJ.
Insights
Cangrelor effectively bridges antiplatelet therapy for spinal cord stimulator procedures, minimizing bleeding risks. This approach ensures patient safety during neuraxial interventions while maintaining therapeutic coverage.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Antiplatelet medications increase bleeding risk during spinal cord stimulator (SCS) procedures.
- Discontinuing antiplatelet therapy is risky for patients with high thromboembolism risk.
- Cangrelor offers a solution by bridging antiplatelet therapy due to its rapid onset and offset.
Observation:
- A 44-year-old male patient with a history of refractory angina underwent SCS.
- The patient was transitioned from prasugrel to cangrelor.
- Cangrelor was discontinued 3 hours before the SCS trial and implant.
Findings:
- The patient experienced no bleeding complications or neurological issues.
- Successful use of cangrelor as an antiplatelet bridge was demonstrated.
Implications:
- Cangrelor can be safely used as an antiplatelet bridge for neuraxial procedures.
- This strategy mitigates bleeding risks associated with SCS trials and implants.
- It allows for continued antiplatelet protection in high-risk patients.
Background:
Antiplatelet medications increase the risk of neuraxial bleeding during spinal cord stimulator (SCS) trials and implants, necessitating adequate discontinuation. However, interrupting antiplatelet therapy is undesirable in patients at high risk for thromboembolism. Cangrelor, a novel nonthienopyridine adenosine triphosphate analog, has a rapid onset and offset that can be used to bridge antiplatelet therapy prior to procedures involving neuraxial access, minimizing the risk of subtherapeutic anticoagulation.
Case Report:
We present the case of a 44-year-old man with an extensive cardiac history who underwent neuromodulation for refractory angina. The patient was transitioned from prasugrel to cangrelor, with cangrelor being discontinued 3 hours prior to the tunneled SCS trial and subsequent implant. He showed no signs of any complications, including neurological issues, related to bleeding.
Conclusions:
This case illustrates the successful use of cangrelor as an antiplatelet bridge prior to a neuraxial procedure.
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