Abstract
Dual antiplatelet therapy is the standard of care for patients with myocardial infarction (MI), who have been resuscitated and treated with therapeutic hypothermia (TH). We compare the antiplatelet effect and bleeding risk of intravenous cangrelor to oral P2Y12-inhibitors in patients with MI receiving TH in a prospective comparison of two matched patient cohorts. Twenty-five patients within the CANGRELOR cohort were compared to 17 patients receiving oral P2Y12-inhibitors. CANGRELOR group (NCT03445546) and the ORAL P2Y12 Group (NCT02914795) were registered at clinicaltrials.gov. Platelet function testing was performed using light-transmittance aggregometry and monitored for 4 days. P2Y12-inhibition was stronger in CANGRELOR compared to ORAL P2Y12 (adenosine diphosphate (ADP) (area under the curve (AUC)) 26.0 (5.9–71.6) vs. 160.9 (47.1–193.7)) at day 1. This difference decreased over the following days as more patients were switched from CANGRELOR to oral P2Y12-inhibitor treatment. There was no difference in the effect of aspirin between the two groups. We did not observe significant differences with respect to thrombolysis in myocardial infarction (TIMI) or Bleeding Academic Research Consortium (BARC) classified bleedings, number of blood transfusions or drop in haemoglobin B (Hb) or hematocrit (Hct) over time. Cangrelor treatment is not only feasible and effective in resuscitated patients, but also inhibited platelet function more effectively than orally administered P2Y12-inhibitors without an increased event rate for bleeding.
Highlights
Dual antiplatelet therapy is the standard treatment for preventing reinfarction and stent thrombosis after coronary stent implantation [1]
In patients suffering from myocardial infarction complicated with resuscitation and having received therapeutic hypothermia, additional challenges must be taken into consideration when determining the course of treatment
This same onset does not take place following the administration of crushed oral P2Y12 inhibitors after placement of a gastric line in the cath lab or even following percutaneous intervention (PCI) while patients are in the intensive care unit (ICU), as recently reported for clopidogrel [20], prasugrel [21], and Ticagrelor [22]
Summary
Dual antiplatelet therapy is the standard treatment for preventing reinfarction and stent thrombosis after coronary stent implantation [1]. Crushing P2Y12 inhibitor tablets is no longer considered a therapeutic limitation as it has not been associated with a reduction in inhibitory effects [3,4,5]. While the first problem can be solved by intravenous administration of the therapy, the second and third problem might impair platelet inhibition independent of the route of administration in this group of patients who are at risk for death and cardiac adverse events. We hypothesised that cangrelor is more potent at inhibiting platelet function compared to oral P2Y12 inhibitors at a comparable bleeding risk. We are the first study to present data regarding the use of cangrelor in this vulnerable patient population and compare the effects to the standard treatment via gastric line
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