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 on a Background of Bivalirudin

The use of bivalirudin in patients undergoing PCI is associated with similar ischemic outcomes and lower bleeding risk than those with heparin plus glycoprotein IIb/IIIa inhibitors. However, bivalirudin is associated with a higher risk of early stent thrombosis.[61] In CHAMPION PHOENIX, the periprocedural anticoagulant choice was at the operator's discretion. Bivalirudin was used in approximately 20 % of the patients (n = 2059). A prespecified subgroup analysis investigated the effect of cangrelor versus clopidogrel in patients in whom physicians chose to use bivalirudin during PCI.[62] In this analysis, cangrelor significantly reduced the risk of the primary efficacy end point of death, MI, IDR, or stent thrombosis at 48 h by 32 %, as compared with clopidogrel, with rates of 4.7 and 6.7 %, respectively (odds ratio 0.68; 95 % CI 0.47–0.99; P = 0.047). This benefit was consistent across multiple subgroups, including patients with stable angina, NSTEACS, or STEMI. In addition, the need for rescue glycoprotein IIb/IIIa inhibitors was also lower in patients receiving cangrelor than in those given clopidogrel (1.4 vs. 3.1 %) (odds ratio 0.44; 95 % CI 0.24–0.84; P = 0.01). Cangrelor also reduced the risk of stent thrombosis by 50 % at 48 h. Notably, this beneficial effect was evident as early as 2 h after randomization. Reassuringly, there was no significant difference in the rate of GUSTO severe or moderate bleeding, TIMI major or minor bleeding, or the need for blood transfusions between the two groups. Taken together, these findings suggest that the attractive antiplatelet profile of cangrelor when combined with bivalirudin has the potential to safely lower ischemic events without increasing the risk of early stent thrombosis in patients undergoing PCI.

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