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Original research
Safety and efficacy of cangrelor in endovascular thrombectomy compared with glycoprotein IIb/IIIa Inhibitors
  1. Alex Devarajan1,
  2. Shouri Gottiparthi1,
  3. Michael T Caton1,
  4. Aya Ouf2,
  5. Katty Wu3,
  6. Daryl Goldman4,
  7. Nicole Davis5,
  8. Nadine Musallam6,
  9. Jack Zhang1,
  10. Naina Rao7,
  11. Neha Dangayach5,
  12. Connor Davy8,
  13. Michael G Fara8,
  14. Shahram Majidi1,
  15. Thomas Oxley1,
  16. Christopher Paul Kellner1,
  17. Tomoyoshi Shigematsu1,
  18. Reade Andrew De Leacy1,
  19. J Mocco1,
  20. Johanna T Fifi1,
  21. Hazem Shoirah1
    1. 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
    2. 2Department of Neurology, University at Buffalo, Buffalo, New York, USA
    3. 3Department of Neurosurgery, SUNY Downstate Medical Center, New York, New York, USA
    4. 4Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
    5. 5Department of Neurocritical Care, Icahn School of Medicine at Mount Sinai, New York, New York, USA
    6. 6Department of Critical Care, Community Regional Medical Center, Lorain, California, USA
    7. 7Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, New York, USA
    8. 8Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
    1. Correspondence to Mr Alex Devarajan; alex.devarajan{at}icahn.mssm.edu

    Abstract

    Background Cangrelor, an intravenous P2Y12-receptor inhibitor, is a reversible and short-acting antithrombotic medication non-inferior to irreversible glycoprotein IIb/IIIa inhibitors (GPIs) like eptifibatide. There are insufficient data to compare the medications in endovascular thrombectomies (EVTs) requiring emergent platelet inhibition.

    Objective To review our institution’s experience with cangrelor in EVT and compares its safety and efficacy against GPIs.

    Methods A large healthcare system retrospective review identified all patients who had received cangrelor or eptifibatide intraoperatively during EVT between December 2018 and March 2023 for this cohort study. Clinical data were reviewed. Functional status was defined by the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) at multiple time points. Multivariate regression was performed.

    Results Of 1010 EVT patients, 36 cangrelor and 104 eptifibatide patients were selected. There were no differences in baseline function or presentations. Cangrelor was frequently administered for stenting tandem occlusions (n=16, 44.4%), and successful reperfusion occurred in 30 (83.3%) patients. On multivariate analysis, cangrelor was associated with decreased odds of hemorrhagic conversion (adjusted OR (aOR)=0.76, P=0.004) and symptomatic hemorrhage (aOR=0.86, P=0.021). There were no differences in thrombotic re-occlusion. Cangrelor was associated with a lower 24-hour NIHSS score (7.0 vs 12.0, P=0.013) and discharge NIHSS score (3.0 vs 9.0, P=0.004). There were no differences in in-hospital mortality or length of stay. Cangrelor was associated with improved odds of favorable outcome, defined as mRS score 0–2, at discharge (aOR=2.69, P=0.001) and on 90-day follow-up (aOR=2.23, P=0.031).

    Conclusion Cangrelor was associated with a decreased risk of hemorrhagic conversion and might lead to favorable functional outcomes for patients during hospitalization in comparison with GPIs. Prospective studies are warranted to investigate its use in EVT.

    • Stroke
    • Thrombectomy
    • Platelets
    • Intervention
    • Drug

    Data availability statement

    Data are available upon reasonable request. All data collected and analyzed for the purposes of this manuscript will be made available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request. All data collected and analyzed for the purposes of this manuscript will be made available upon reasonable request.

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    Footnotes

    • X @AlexDevarajan, @Majidishahram, @chriskellnerMD, @rdeleacymd, @Shoirahz

    • Presented at This abstract was previously presented as a podium presentation at the Society of Neurointerventional Surgery’s 20th Annual Meeting in San Diego, CA from July 31– August 4, 2023.

    • Contributors Conceptualization: AD, AO, KW, NDav, NM, HS. Methodology: AD, AO, HS. Data curation: AD, SG, MTC, AO, KW, JZ. Formal data analysis and investigation: AD, SG, MTC, DG, JZ, NR, HS. Original draft preparation: AD, SG, DG, NDav, NDan. Review and editing of the manuscript: AD, SG, MTC, AO, DG, NDav, NM, JZ, NR, NDan, CD, MF, SM, TO, CPK, TS, RADL, JM, JTF, HS. Project supervision: NDan, CD, MEF, SM, TO, CPK, TS, RADL, JM, JTF, HS. Guarantor: AD, HS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Disclosures: JTF and JM are members of the Society of Neurointerventional Surgery Board of Directors.

    • Provenance and peer review Not commissioned; externally peer reviewed.