Key result
Cangrelor during PCI linked to rare early fatal bleeding and stent thrombosis.
Why the study?
More experience with cangrelor use in acute PCI with unknown bleeding risk is needed.
Observational (n=991)
No
Real-world use of intravenous cangrelor during acute PCI demonstrates its feasibility, with rare but notable occurrences of fatal bleeding and stent thrombosis within 48 hours.
Cangrelor in PCI warrants vigilance for fatal bleeding and early stent thrombosis; this Level 3 cohort study leaves open its net safety versus alternatives.
Background. Reversible P2Y12 inhibition can be obtained with cangrelor administered intravenously. More experience with cangrelor use in acute PCI with unknown bleeding risk is needed. Objectives. To describe real-world use of cangrelor including patient and procedure characteristics and patient outcomes. Methods. We performed a single-centre, retrospective, and observational study including all patients treated with cangrelor in relation to percutaneous coronary intervention at Aarhus University Hospital during the years 2016, 2017, and 2018. We recorded procedure indication and priority, the indications for cangrelor use, and patient outcomes within the first 48 hours after initiation of cangrelor treatment. Results. We treated 991 patients with cangrelor in the study period. Of these, 869 (87.7%) had an acute procedure priority. Among acute procedures, patients were mainly treated for STEMI (n = 723) and the remaining were treated for cardiac arrest and acute heart failure. Use of oral P2Y12 inhibitors prior to percutaneous coronary intervention was rare. Fatal bleeding events (n = 6) were only observed among patients undergoing acute procedures. Stent thrombosis was observed in two patients receiving acute treatment for STEMI. Thus, cangrelor can be used in relation to PCI under acute circumstances with advantages in terms of clinical management. The benefits and risks, in terms of patient outcomes, should ideally be assessed in randomized trials.
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Thim et al. (2023) conducted an observational in Percutaneous coronary intervention (n=991). Cangrelor was evaluated on Patient outcomes within the first 48 hours. Cangrelor use during percutaneous coronary intervention was associated with 6 fatal bleeding events and 2 cases of stent thrombosis within 48 hours among 991 treated patients.
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