Cangrelor infusion during PCI provided moderate platelet inhibition with 3.2% high residual platelet reactivity, though switching to oral inhibitors caused transient HRPR in up to 37.9% of patients.
Observational (n=150)
Does cangrelor infusion and subsequent switch to oral P2Y12 inhibitors provide adequate platelet inhibition in patients undergoing PCI?
Switching from cangrelor to oral P2Y12 inhibitors, particularly clopidogrel, exposes a significant proportion of patients to high residual platelet reactivity in the hours following PCI.
BACKGROUND: inhibitor-naïve patients undergoing percutaneous coronary intervention (PCI). Pharmacodynamic (PD) investigations in various clinical settings, with various assays, have shown contrasting data in terms of the extent of platelet inhibition and rates of high residual platelet reactivity (HRPR). AIMS: We aimed to assess the PD effects of cangrelor in all patients receiving it during PCI. METHODS: PharmacOdynaMic Effects of Cangrelor in PatiEnts wIth Acute or chronIc Coronary Syndrome Undergoing Percutaneous Coronary Intervention (POMPEII Registry; ClinicalTrials.gov: NCT04790032) is an investigator-initiated, prospective study assessing PD effects at 4 timepoints with 3 assays. Clinical outcomes at 30 days were also assessed. RESULTS: From March 2021 to June 2024, 150 patients undergoing PCI and receiving cangrelor were enrolled (64 patients underwent elective PCI; 30 had non-ST-elevation acute coronary syndrome; and 56 had ST-segment elevation myocardial infarction STEMI, of whom 24 were pretreated with ticagrelor). Most patients switched from cangrelor to either clopidogrel or ticagrelor. Inhibition of platelet aggregation was moderate during cangrelor infusion (light transmittance aggregometry with adenosine diphosphate 20 μM: 57.6±16.5%), with rates of 3.2% for HRPR and 1.3% for bailout tirofiban. Rates of HRPR were relevant at 3 h (37.9%) and 4-6 h (15.3%), and HRPR occurred significantly more frequently in patients switching to clopidogrel compared with ticagrelor. Rates of ischaemic and bleeding events were low. CONCLUSIONS: inhibitor, mainly clopidogrel, exposed a large number of patients to a variable period of on-treatment HRPR.
Gargiulo et al. (Thu,) conducted a observational in Acute or chronic coronary syndrome undergoing percutaneous coronary intervention (n=150). Cangrelor was evaluated on Pharmacodynamic effects (inhibition of platelet aggregation and high residual platelet reactivity). Cangrelor infusion during PCI provided moderate platelet inhibition with 3.2% high residual platelet reactivity, though switching to oral inhibitors caused transient HRPR in up to 37.9% of patients.