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

Cangrelor in Older Patients

Advancing age is one of the most important predictors of mortality and morbidity in patients with ACS. Older patients (≥75 years) have more complex coronary anatomy, more comorbidities and are at an increased risk of periprocedural thrombotic and bleeding events after PCI than younger patients (<75 years).[55,56] Improved PCI techniques and advances in antithrombotic therapy have improved outcomes in older patients.[57] However, there is a paucity of evidence to direct treatment in this patient population, as older patients have been excluded in most clinical trials. Consequently, older patients who present with ACS are less likely to receive guideline-directed therapies, including PCI, particularly because of concerns for bleeding.[58,59] Periprocedural bleeding in older patients is well known to increase the risk of adverse events, including death, MI, stroke, and prolonged hospitalization.

In a prespecified subgroup of 2010 older patients (≥75 years; ~20 % of study participants) in CHAMPION PHOENIX, cangrelor compared with clopidogrel was shown to reduce ischemic events without increasing severe bleeding events; consistent with the effect in younger patients (<75 years).[60] In older patients, the primary end point of death, MI, IDR, or stent thrombosis occurred in 5.4 % of patients in the cangrelor group versus 7.4 % in the clopidogrel group (odds ratio 0.71; 95 % CI 0.50–1.02). There was no significant difference in the rates of GUSTO severe bleeding between the two groups (odds ratio 0.58; 95 % CI 0.14–2.44). Furthermore, the frequency of the net composite end point of death, MI, IDR, stent thrombosis, or GUSTO severe bleeding was lower in older patients treated with cangrelor than clopidogrel (odds ratio 0.71; 95 % CI 0.50–1.01; P = 0.06). These data provide strong evidence for the potential role of cangrelor in safely optimizing antiplatelet therapy in older patients undergoing PCI.

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