November 30, 2016JAMA Cardiology
Evaluation of Ischemic and Bleeding Risks Associated With 2 Parenteral Antiplatelet Strategies Comparing Cangrelor With Glycoprotein IIb/IIIa Inhibitors
Key result
Cangrelor alone yields similar ischemic events but lower TIMI bleeding versus clopidogrel-GPIs.
- OR 0.79
- 95% CI 0.48-1.32
- n=12,140
Why the study?
Optimal antiplatelet management with PCI in the context of contemporary pharmacotherapy has not been well established, particularly comparing cangrelor and GPIs.
Does cangrelor alone reduce ischemic and bleeding risks compared to clopidogrel with routine glycoprotein IIb/IIIa inhibitors in patients undergoing PCI?
Population
12,140 patients undergoing elective or nonelective PCI
Comparison
Cangrelor alone vs clopidogrel (or placebo) with routine GPIs
Design
Exploratory pooled patient-level analysis of 3 phase 3 randomized trials with 1:1 propensity score matching
Follow-up
48 hours
Authors
Discussion
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Member takes
Implication
Similar ischemic protection with lower bleeding supports cangrelor alone in PCI; reinforces bleeding minimization in matched antiplatelet analyses.
Structured PICO
Does cangrelor alone reduce ischemic and bleeding risks compared to clopidogrel with routine glycoprotein IIb/IIIa inhibitors in patients undergoing PCI?
P
Population
12,140 patients undergoing elective or nonelective PCI, analyzed via propensity score matching to compare cangrelor alone versus clopidogrel with routine GPIs.
I
Intervention
Cangrelor alone (without glycoprotein IIb/IIIa inhibitors)
C
Comparator
Clopidogrel (or placebo) and routine glycoprotein IIb/IIIa inhibitors (GPIs)
O
Outcome
Composite of all-cause mortality, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hourscomposite
Main Result
Odds Ratio: 0.79 (95% CI 0.48–1.32)
Absolute Event Rate: 2.6% vs 3.3%
In patients undergoing PCI, cangrelor alone provides similar ischemic protection but significantly lower bleeding risk compared to clopidogrel plus routine glycoprotein IIb/IIIa inhibitors.
Cite This Study
Vaduganathan et al. (2016) studied Patients undergoing PCI (n=12,140). Cangrelor alone vs. Clopidogrel (or placebo) and routine GPIs was evaluated on Composite of all-cause mortality, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours (OR 0.79, 95% CI 0.48-1.32). Cangrelor alone was associated with similar rates of the primary ischemic composite endpoint compared with clopidogrel-GPIs (2.6% vs 3.3%; OR 0.79; 95% CI 0.48-1.32) and lower TIMI bleeding.