Cangrelor as an Effective Bridge in Patients Requiring Percutaneous Coronary Intervention and Temporary Mechanical Support

Abstract

Objectives Describe the experience at our institution using cangrelor during T-MCS as a bridge to durable support or weaning, including hematological complications and mortality. Background In patients with cardiogenic shock, temporary mechanical circulatory support (T-MCS) devices can provide cardiac or cardiopulmonary support as a bridge to myocardial recovery or need for long-term support. Intravenous cangrelor presents a promising drug therapy for maintaining adequate platelet inhibition while bridging to decision Methods This retrospective, cohort study included all patients from 06/22/2015 through 01/31/2018 who received cangrelor as a second antiplatelet therapy in addition to aspirin while being supported with a T-MCS device at a single large tertiary care center. The primary outcome was major bleeding according to the ELSO definition. Secondary endpoints included all cause index hospitalization mortality, decision to withdraw care, minor bleeding, stent thrombosis confirmed by angiography, and thromboembolic event confirmed by imaging during the patient's index hospitalization. Additional secondary endpoints were 1-year survival, and 1-year major adverse cardiac event rate. Results The primary outcome major bleeding occurred in four of ten cases. Four of the remaining six cases had a minor bleeding event. There were no episodes of acute/subacute stent thrombosis in the eight patients who received a drug-eluting stent. All cause index hospitalization mortality occurred in 60%, of which 5 patients had care withdrawn due to futility. None of the patients had a catastrophic bleeding event. Conclusions Our case series suggests a potential benefit of cangrelor as a bridge in patients requiring PCI and temporary mechanical support.