cangrelor and Drug-Related-Side-Effects-and-Adverse-Reactions

Dyspnoea may be induced by some reversibly-binding P2Y

Topics: Adenosine Monophosphate; Aged; Clopidogrel; Coronary Occlusion; Double-Blind Method; Drug-Related Side Effects and Adverse Reactions; Dyspnea; Female; Humans; Intention to Treat Analysis; Male; Middle Aged; Percutaneous Coronary Intervention; Receptors, Purinergic P2Y12; Survival Analysis; Ticlopidine; Treatment Outcome; Withholding Treatment

Oral P2Y₁₂ platelet receptor inhibitors are a cornerstone of reducing complications in patients with acute coronary syndromes or coronary stents. Guidelines advocate discontinuing treatment with P2Y₁₂ platelet receptor inhibitors before surgery. Cangrelor, a short-acting, reversible, intravenously administered P2Y₁₂ platelet inhibitor is effective in achieving appropriate platelet inhibition in patients who are awaiting coronary artery bypass grafting (CABG) and require P2Y₁₂ inhibition. The objective of this study was to assess the effects of preoperative cangrelor on the incidence of perioperative complications, which are currently unknown.. Patients (n = 210) requiring preoperative clinical administration of thienopyridine therapy were randomized in a multicenter, double-blinded study to receive cangrelor or placebo while awaiting CABG after discontinuation of the thienopyridine. Optimal platelet reactivity, which was defined as <240 P2Y₁₂ platelet reaction units, was measured with serial point-of-care testing (VerifyNow). Pre- and postoperative outcomes, bleeding values, and transfusion rates were compared. To quantify potential risk factors for bleeding, we developed a multivariate logistic model.. The differences between the groups in bleeding and perioperative transfusion rates were not significantly different. The rate of CABG-related bleeding was 11.8% (12/102) in cangrelor-treated patients and 10.4% (10/96) in the placebo group (P = .763). Transfusion rates for the groups were similar. Serious postoperative adverse events for the cangrelor and placebo groups were 7.8% (8/102) and 5.2% (5/96), respectively (P = .454).. Compared with placebo, bridging patients with cangrelor prior to CABG effectively maintains platelet inhibition without increasing post-CABG complications, including bleeding and the need for transfusions. These data suggest cangrelor treatment is a potential strategy for bridging patients requiring P2Y₁₂ receptor inhibition while they await surgery.

Topics: Adenosine Monophosphate; Administration, Oral; Adult; Aged; Aged, 80 and over; Blood Transfusion; Coronary Artery Bypass; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Injections, Intravenous; Male; Middle Aged; Placebo Effect; Platelet Aggregation Inhibitors; Postoperative Hemorrhage; Premedication; Prevalence; Purinergic P2Y Receptor Antagonists; Pyridines; Risk Assessment; Treatment Outcome; United States

Topics: Adenosine Monophosphate; Aged; Anxiety; Chest Pain; Coronary Angiography; Coronary Occlusion; Drug Substitution; Drug-Eluting Stents; Drug-Related Side Effects and Adverse Reactions; Dyspnea; Electrocardiography; Humans; Inferior Wall Myocardial Infarction; Male; Percutaneous Coronary Intervention; Purinergic P2Y Receptor Antagonists; ST Elevation Myocardial Infarction; Ticagrelor; Treatment Outcome; Withholding Treatment