Bleeding complications in patients with out-of-hospital cardiac arrest treated with cangrelor and oral P2Y12 inhibitors

AIMS: Cangrelor is used to bridge the gap of insufficient platelet inhibition in patients with out-of-hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: In a retrospective chart review study, we investigated the incidence of bleeding and stent thrombosis in patients with OHCA undergoing PCI who received either cangrelor and transition to an oral P2Y12 inhibitor or an oral P2Y12 inhibitor alone. Subgroups consisted of patients treated with conventional cardiopulmonary resuscitation (CPR) and extracorporeal CPR. The primary endpoint was Bleeding Academic Research Consortium (BARC) 3-5 bleeding at 30 days. Between January 2016 and March 2025, 414 patients were included of which 267 received cangrelor and an oral P2Y12 inhibitor and 147 received an oral P2Y12 inhibitor alone. BARC 3-5 bleeding at 30 days occurred at a similar rate in the cangrelor group and the oral P2Y12 inhibitor group (18.4% vs. 19.0%, respectively; adjusted OR, 0.79; 95% CI, 0.45-1.39). BARC 3-5 bleeding at 6, 24 and 48 h was similar between the cangrelor group and the oral P2Y12 inhibitor group in patients treated with conventional and extracorporeal CPR. In patients treated with extracorporeal CPR, stent thrombosis occurred less frequently in the cangrelor group compared with the oral P2Y12 inhibitor group (2.1% vs. 4.5%, respectively; adjusted OR, 0.32, 95% CI, 0.03-3.14), but without reaching statistical significance. CONCLUSION: In patients with OHCA undergoing PCI, BARC 3-5 bleeding occurred at a similar rate in patients receiving either cangrelor and transition to an oral P2Y12 inhibitor or an oral P2Y12 inhibitor alone.