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Use of Cangrelor in Türkiye: A Multicenter Real-Life Study
Servet Altay1, İlker Gül2, Fatih Aytemiz3
1Department of Cardiology, Trakya University Faculty of Medicine, 22030 Edirne, Türkiye.
Insights
This study shows cangrelor is effective and safe for high-risk patients undergoing percutaneous coronary intervention (PCI) in Türkiye. Real-world data confirm its utility when oral P2Y12 inhibitors are not feasible, with low bleeding rates.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Cangrelor is the sole intravenous P2Y12 inhibitor for acute and chronic coronary syndromes.
- Existing research confirms cangrelor's efficacy, but real-world usage data remain limited.
- This study addresses the need for real-world evidence on cangrelor in high-volume percutaneous coronary intervention (PCI) centers.
Purpose of the Study:
- To investigate cangrelor utilization in large-volume PCI centers in Türkiye.
- To analyze indications, patient demographics, and clinical outcomes, including bleeding and ischemic events.
- To evaluate the efficacy and safety of cangrelor in a high-risk patient cohort.
Main Methods:
- Retrospective analysis of 411 patients from 14 high-volume centers in Türkiye with extensive cangrelor experience.
- Data collected on cangrelor indications, patient characteristics, treatments, and in-hospital/follow-up events.
- Analysis included bleeding events (any and major), ischemic events, and mortality.
Main Results:
- Common indications for cangrelor included cardiogenic shock and inability to take oral P2Y12 inhibitors due to nausea/vomiting or intubation.
- Overall bleeding incidence within 48 hours was 6.4%, with major bleeding at 1.7%.
- Bleeding rates were comparable across age groups (<75 vs. ≥75 years) and in patients with/without chronic kidney disease (CKD).
Conclusions:
- This is the first large-scale, multicenter study on cangrelor use in Türkiye.
- Provides crucial real-world evidence supporting cangrelor's efficacy and safety in high-risk PCI patients.
- Highlights cangrelor's value in complex clinical scenarios where oral P2Y12 inhibitors are not suitable.
Abstract:
Background/Objectives: The only intravenous P2Y12 inhibitor used in the management of acute and chronic coronary syndromes is cangrelor. Previous studies have demonstrated the efficacy of cangrelor. However, limited real-world data are available for cangrelor usage. This study aimed to investigate the use of cangrelor in large-volume percutaneous coronary intervention (PCI) centers in Türkiye, and examine the indications, patient characteristics, bleeding, and ischemic events. The efficacy and safety of cangrelor in this high-risk group were evaluated. Methods: This study was conducted retrospectively in 14 high-volume centers in Türkiye with extensive cangrelor experience. Cangrelor indications, patient clinical characteristics, periprocedural and postprocedural treatments, in-hospital and follow-up bleeding, ischemic events, and mortality were analyzed. Results: This study recruited 411 patients (mean age: 63.8 ± 12.7 years; 76% male). The most common conditions in which cangrelor is used in Türkiye are cardiogenic shock, intubation and nausea/vomiting, where P2Y12 cannot be used adequately due to impaired oral intake. The incidence rate of any bleeding within 48 h was 6.4% (n = 26), with major bleeding accounting for 1.7% of all cases (n = 7). The bleeding rates were similar between patients aged <75 years and those aged ≥75 years (6.0% vs. 8.8%, p = 0.326), as well as between patients with chronic kidney disease (CKD) and those without CKD (6.3% vs. 7.9%, p = 0.600). Conclusions: This is the first multicenter, large-cohort study to examine cangrelor use in Türkiye, providing real-world evidence for the efficacy and safety in high-risk patients with complex clinical features and lesion characteristics.
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