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

Net Clinical Benefit of Cangrelor in Women

Women are underrepresented in cardiovascular clinical trials relative to their disease prevalence.[50] Because of the paucity of data, the impact of antiplatelet therapy on thrombotic and bleeding risks in women treated with PCI remains uncertain. In particular, concerns have been raised about the heterogeneity in net clinical benefit of antiplatelet therapy between men and women.[51–53] As a result, many physicians may withhold evidence-based antithrombotic therapies in women. In a prespecified subgroup analysis of the CHAMPION PHOENIX trial, cangrelor showed consistent reductions in periprocedural and 30-day ischemic events in both men and women.[54] Of the 11,145 patients enrolled in the CHAMPION PHOENIX trial, 28 % (n = 3051) were women. In women, cangrelor compared with clopidogrel reduced the rate of the primary efficacy end point by 35 % (odds ratio 0.65; 95 % CI 0.48–0.89; P = 0.01) and decreased the incidence of stent thrombosis by 61 % (odds ratio 0.39; 95 % CI 0.20–0.77; P = 0.01). In men, treatment with cangrelor resulted in a 14 % reduction in the odds of the primary efficacy end point (odds ratio 0.86; 95 % CI 0.70–1.05; P = 0.014; P interaction = 0.23) and a 16 % reduction in the odds of stent thrombosis (odds ratio 0.84; 95 % CI 0.53–1.33; P = 0.44; P interaction = 0.11). In addition, cangrelor compared with clopidogrel did not increase the rate of the primary safety end point, GUSTO severe or life threatening bleeding, in either women or men. Importantly, net clinical benefit, a composite of the primary efficacy and safety end points, favored cangrelor over clopidogrel in both women and men. These findings provide reassurance regarding the efficacy and safety of cangrelor in women undergoing PCI.

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