Optimizing the Use of Cangrelor in the Real World

Arman Qamar; Deepak L. Bhatt

Disclosures

Am J Cardiovasc Drugs. 2017;17(1):5-16. 

In This Article

Effect of Cangrelor According to Access Site

Bleeding has been associated with an increased risk of subsequent ischemic events including, death, MI, stroke, and stent thrombosis in patients treated with PCI.[63,64] Vascular access site complications are the most common cause of bleeding in patients undergoing PCI. Compared with the femoral approach, the radial artery approach reduces bleeding, adverse cardiac events, and the cost of hospitalization.[65] Of the 11,145 patients randomized in CHAMPION PHOENIX, 74 % underwent PCI via femoral access and 26 % through the radial approach. In a prespecified subgroup analysis, Gutierrez et al. explored the benefit of cangrelor according to the access site (femoral vs. radial) used for PCI.[66] In the radial group, the rate of the primary efficacy end point of death, MI, IDR, or stent thrombosis at 48 h was lower in patients receiving cangrelor than clopidogrel (4.4 vs. 5.7 %) (odds ratio 0.76; 95 % CI 0.54–1.06). Similarly, in the femoral group, the use of cangrelor was associated with a reduction in the rate of the primary efficacy end point compared with clopidogrel (4.8 vs. 6.0 %) (odds ratio 0.79; 95 % CI 0.65–0.96; P interaction = 0.83). In both radial and femoral groups, there was no significant difference in the risk of GUSTO severe bleeding, TIMI major bleeding, or blood transfusions in patients treated with cangrelor versus clopidogrel. However, the absolute rates of GUSTO severe bleeding, TIMI major bleeding, or blood transfusions were higher in the femoral group than in the radial group, irrespective of treatment with cangrelor or clopidogrel.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....