January 17th, 2012

Cangrelor Proposed as Bridge to Surgery

As a potent and reversible platelet inhibitor, cangrelor has been proposed for use in a bridging strategy for patients scheduled for surgery who are currently taking clopidogrel or another thienopyridine. To test this strategy, the BRIDGE investigators randomized 210 ACS or stent patients awaiting CABG and taking a thienopyridine to receive either cangrelor or placebo for at least 48 hours prior to surgery.

During the treatment period, platelet reactivity was lower in the cangrelor group than in the placebo group. There was no significant difference in the rate of surgery-related bleeding.

  • Platelet inhibition (defined as PRU <240) occurred in 98.8% of patients in the cangrelor group compared with 19.0% of patients in the placebo group (RR 5.2, CI 3.3-8.1, p< 0.001).
  • Excessive CABG surgery–related bleeding occurred in 11.8% of the cangrelor group compared with 10.4% of the placebo group (RR  1.1, CI 0.5-2.5, p=0.763).

Writing in JAMA, the researchers conclude:

Our data support the hypothesis that intravenous cangrelor is a feasible management strategy in patients waiting for cardiac surgery who require prolonged platelet P2Y12 inhibition after thienopyridine discontinuation.

(For our Interventional Cardiology co-moderators’ take on this study, click here.)

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