Introduction Cangrelor, an intravenous P2Y12-receptor inhibitor, is a reversible and short-acting antithrombotic medication that has been demonstrated to be non-inferior to traditional irreversible Glycoprotein IIb-IIIa inhibitors (GPI) such as eptifibatide. It has lower hemorrhagic risk and is used to prevent thrombotic complications in cardiologic interventions. However, its effectiveness in endovascular thrombectomy (EVT), which can require emergent platelet inhibition, is not well characterized. This study reviews our institution’s experience with cangrelor in EVT and compares its safety and efficacy against GPIs.
Methods A single-center retrospective review identified all patients who received cangrelor or eptifibatide intraoperatively while undergoing EVT for management of acute stroke. Clinical data including baseline medications and comorbidities, dosing, adjunctive antiplatelet therapy, hemorrhagic complications, vessel or stent patency, hospital course, and functional status as defined by the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) at baseline and at multiple time points during and after hospitalization were reviewed. Binary variables were tested with Pearson χ2 tests or Fisher’s exact tests. Continuous variables were tested with two-tailed t-tests or Wilcoxon tests.
Results Out of 1,010 EVT patients, 36 patients who received cangrelor and 104 patients who received eptifibatide intra-procedurally were selected. There were no significant differences in baseline mRS, initial NIHSS score, or prior administration of intravenous thrombolysis. Cangrelor usage during EVT was associated with a significantly decreased risk of hemorrhagic conversion (41.3% vs 22.2%, p<0.05). There is a trend to decreased risk of symptomatic hemorrhage (15.4% vs 8.33%, p=0.4). Intraprocedural cangrelor was most frequently administered for stenting of tandem occlusions (n=16, 44.4%) and successful reperfusion confirmed with follow-up vascular imaging occurred in 94.44% of patients (n=34). There were no significant differences in thrombotic reocclusion of the stent or vessel or mortality during the hospitalization. Cangrelor usage was associated with significantly lower 24-hour and discharge NIHSS scores (p<0.05). Cangrelor usage was associated with significantly increased rate of favorable outcome, defined as a mRS of 0-2, at discharge (p<0.05). This was not seen on 30-day (p=0.09) or 90-day follow-up (p=0.32).
Conclusion Cangrelor use was associated with a decreased risk of hemorrhagic conversion and may lead to favorable functional outcomes for patients during hospitalization when compared to GPI use. Future prospective studies are warranted to investigate its use in EVT.
Disclosures A. Devarajan: None. S. Gottiparthi: None. J. Zhang: None. D. Goldman: None. A. Schupper: None. C. Rossitto: None. J. Scaggiante: None. M. Al-Kawaz: None. B. Kim: None. N. Musallam: None. N. Davis: None. K. Wu: None. A. Ouf: None. D. Klavansky: None. S. Majidi: None. J. Liang: None. T. Shigematsu: None. J. Mocco: None. J. Fifi: None. H. Shoirah: None.
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