Among 17 patients receiving cangrelor during mechanical circulatory support after PCI, 59% experienced a bleeding event, no patients developed in-stent thrombosis, and 82% survived.
Observational (n=17)
No
What are the bleeding complications and clinical outcomes associated with cangrelor use in patients requiring mechanical circulatory support after percutaneous coronary intervention?
In patients requiring mechanical circulatory support after PCI, cangrelor use as part of triple antithrombotic therapy was associated with a high rate of bleeding (59%) but no in-stent thrombosis, suggesting lower doses (<0.75 µg/kg/min) might be preferable.
BACKGROUND: Patients with cardiogenic shock after percutaneous coronary intervention (PCI) may require mechanical circulatory support (MCS). The combination of dual antiplatelet therapy with cangrelor and continuous anticoagulation required for MCS may increase the risk of bleeding. OBJECTIVE: The objective of the study is to describe the complications and outcomes of patients who received cangrelor during MCS following PCI. METHODS: This is a single-center, retrospective, observational case series of 17 patients who received cangrelor while on MCS from June 2017 to September 2019. RESULTS: In a case series of 17 patients, 8 patients (47%) were supported with an Impella device and 4 patients (24%) with venoarterial (VA) extracorporeal membrane oxygenation (ECMO); 5 required (29%) concomitant VA ECMO and Impella support in the setting of cardiogenic shock. All patients received triple antithrombotic therapy with aspirin, heparin, and cangrelor. Cangrelor was commonly initiated at a median dose of 0.75 (range 0.5-4) µg/kg/min. Cangrelor dose adjustments included changes in increments up to 0.25 µg/kg/min with review of P2Y12 levels. A total of 10 patients (59%) experienced a bleeding event, most commonly located at the peripheral cannulation site (40%) and in the gastrointestinal tract (30%). Seven (70%) and 3 (30%) of the bleeding complications were classified as major and minor, respectively. No patient developed in-stent thrombosis during the hospitalization; 14 (82%) patients survived their MCS course. CONCLUSION AND RELEVANCE: This case series suggests that cangrelor doses less than 0.75 µg/kg/min may be beneficial. Larger studies should evaluate alternative dosing regimens.
Katz et al. (Wed,) conducted a observational in Cardiogenic shock after percutaneous coronary intervention requiring mechanical circulatory support (n=17). Cangrelor was evaluated on Bleeding events. Among 17 patients receiving cangrelor during mechanical circulatory support after PCI, 59% experienced a bleeding event, no patients developed in-stent thrombosis, and 82% survived.