Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery.

Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery.

Firstenberg Michael S; Dyke Cornelius M; Angiolillo Dominick J; Ramaiahm Chandrashekar; Price Matthew; Brtko Miroslav; Welsby Ian; Chandna Harish; Holmes David R; Voeltz Michele; Tummala Pradyumna; Hutyra Martin; Manoukian Steven V; Prats Jayne; Todd Meredith; Liu Tiepu; Chronos Nicholas; Dietrich Markus; Montalescot Gilles; Cannon Louis A; Topo Eric J

The heart surgery forum

2013

2013-04

OBJECTIVE: Oral P2Y(1)(2) platelet receptor inhibitors are a cornerstone of reducing complications in patients with acute coronary syndromes or coronary stents. Guidelines advocate discontinuing treatment with P2Y(1)(2) platelet receptor inhibitors before surgery. Cangrelor, a short-acting, reversible, intravenously administered P2Y(1)(2) platelet inhibitor is effective in achieving appropriate platelet inhibition in patients who are awaiting coronary artery bypass grafting (CABG) and require P2Y(1)(2) inhibition. The objective of this study was to assess the effects of preoperative cangrelor on the incidence of perioperative complications, which are currently unknown. METHODS: Patients (n = 210) requiring preoperative clinical administration of thienopyridine therapy were randomized in a multicenter, double-blinded study to receive cangrelor or placebo while awaiting CABG after discontinuation of the thienopyridine. Optimal platelet reactivity, which was defined as \textless240 P2Y(1)(2) platelet reaction units, was measured with serial point-of-care testing (VerifyNow). Pre- and postoperative outcomes, bleeding values, and transfusion rates were compared. To quantify potential risk factors for bleeding, we developed a multivariate logistic model. RESULTS: The differences between the groups in bleeding and perioperative transfusion rates were not significantly different. The rate of

Adult; Female; Humans; Male; Middle Aged; Aged; Treatment Outcome; Prevalence; United States/epidemiology; Risk Assessment; Adenosine Monophosphate/administration & dosage/*analogs & derivatives; Blood Transfusion/*statistics & numerical data; Coronary Artery Bypass/*statistics & numerical data; Drug-Related Side Effects and Adverse Reactions/epidemiology; Placebo Effect; Platelet Aggregation Inhibitors/administration & dosage; Postoperative Hemorrhage/*epidemiology/*prevention & control; Premedication/*statistics & numerical data; Purinergic P2Y Receptor Antagonists/administration & dosage; Pyridines/*administration & dosage; Injections; 80 and over; Intravenous; Administration; Drug Therapy; Oral; Combination/statistics & numerical data

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E60–69

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