Key result
Perioperative cangrelor bridging in patients requiring interruption of antiplatelet therapy resulted in a 22% incidence of bleeding events, of which most were minor.
Why the study?
In patients with a cardiac stent requiring urgent procedures necessitating DAPT interruption, the safety and effectiveness of intravenous cangrelor bridging in a veteran population needed evaluation.
Does perioperative cangrelor bridging prevent ischemic events and minimize bleeding in patients with cardiac stents requiring DAPT interruption for urgent procedures?
Cohort (n=41)
Yes
Does perioperative cangrelor bridging prevent ischemic events and minimize bleeding in patients with cardiac stents requiring DAPT interruption for urgent procedures?
Cangrelor bridging appears to be a reasonable and safe alternative for patients with cardiac stents requiring temporary interruption of oral P2Y12 inhibitors for urgent invasive procedures.
Cangrelor bridging was associated with low ischemic and mostly minor bleeding rates; leaves open confirmation in randomized perioperative trials.
BACKGROUND: In patients who received a cardiac stent, practice guidelines recommend dual antiplatelet therapy (DAPT). However, an urgent procedure may be required necessitating interruption of DAPT. Intravenous cangrelor was previously shown to be an alternative due its short-half life and quick onset/offset. OBJECTIVE: To determine the safety and effectiveness of cangrelor bridging for patients undergoing invasive procedures in a veteran population. METHODS: Retrospective cohort of patients from Michael E. DeBakey VA Medical Center and the VA North Texas Health Care Systems who underwent perioperative cangrelor bridging. The primary outcome was the incidence of bleeding using the Bleeding Academic Research Consortium (BARC) criteria. The secondary outcome was a composite of nonfatal stroke, myocardial infarction (MI), mortality, and unplanned revascularization within 30 days. A narrative review was also performed to summarize cangrelor bridging for noncardiac invasive procedure. RESULTS: There were 41 patients that met the eligibility criteria. Patients were predominantly Caucasian (57.5%) men with a median age of 70 years. The median duration on cangrelor bridging was 2.6 days with 11 and 30 patients undergoing cardiac and noncardiac invasive procedures, respectively. Nine patients (22%) had a bleeding event of which 8 were minor. One was severe due to significant iliopsoas hematoma following drain placement. All bleeding events occurred postoperatively except for 2 perioperative events that occurred during orthopedic procedures. Ischemic events up to 30 days occurred in 3 patients (7.3%) which consisted of 1 (2.4%) nonfatal MI requiring revascularization and 2 (4.9%) deaths, 1 of which was sudden cardiac. CONCLUSION AND RELEVANCE: This study suggests that cangrelor bridging may be a reasonable alternative to holding oral P2Y12 inhibitors in patients requiring interruption of antiplatelet therapy for an urgent surgery/invasive procedure.
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Salgia et al. (2022) conducted a cohort in Patients requiring interruption of antiplatelet therapy for an urgent surgery/invasive procedure (n=41). Perioperative cangrelor bridging was evaluated on incidence of bleeding using the Bleeding Academic Research Consortium (BARC) criteria. Perioperative cangrelor bridging in patients requiring interruption of antiplatelet therapy resulted in a 22% incidence of bleeding events, of which most were minor.
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