January 17, 2012JAMA
Bridging Antiplatelet Therapy With Cangrelor in Patients Undergoing Cardiac Surgery
Why the study?
Does cangrelor improve maintenance of platelet inhibition in patients with ACS or coronary stents awaiting CABG surgery?
Population
210 patients with an acute coronary syndrome or treated with a coronary stent and receiving a thienopyridine…
Comparison
Cangrelor 0.75 μg/kg per minute intravenous for… vs Matching placebo for at least 48 hours…
Design
RCT, randomized, double-blind, placebo-controlled
Follow-up
at least 48 hours (until 1 to 6 hours before CABG surgery)
Authors
Discussion
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Implication
Supports cangrelor bridging to sustain platelet inhibition pre-CABG; extends RCT evidence for periprocedural P2Y12 management in ACS.
Structured PICO
Does cangrelor improve maintenance of platelet inhibition in patients with ACS or coronary stents awaiting CABG surgery?
P
Population
210 patients with an acute coronary syndrome (ACS) or treated with a coronary stent and receiving a thienopyridine awaiting CABG surgery
I
Intervention
Cangrelor 0.75 μg/kg per minute intravenous for at least 48 hours, discontinued 1 to 6 hours before CABG surgery
C
Comparator
Matching placebo for at least 48 hours, discontinued 1 to 6 hours before CABG surgery
O
Outcome
Platelet reactivity (measured in P2Y12 reaction units [PRUs]), assessed dailysurrogate
In patients discontinuing thienopyridines before cardiac surgery, bridging with intravenous cangrelor effectively maintains platelet inhibition without significantly increasing major bleeding.
Cite This Study
Angiolillo et al. (2012) studied this question.