Antiplatelet Therapy Bridging With Cangrelor in Patients With Coronary Stents: A Case Series

Background: Cangrelor is an intravenous P2Y(12) receptor antagonist approved for use during percutaneous coronary intervention (PCI) to reduce ischemic events associated with new stent placement and has been used off-label at reduced doses guided by platelet function testing as a "bridge" from discontinuation of oral P2Y(12) receptor antagonists to surgical procedures when the long-term effects of oral agents are undesirable. Objective: To describe the dosing, laboratory monitoring, and clinical outcomes of a series of patients who received cangrelor as a "bridging" antiplatelet agent. Methods: This study is a retrospective analysis of all patients within the study center with coronary stents who received cangrelor as a bridge to surgical procedure and had VerifyNow monitoring during treatment. Results: A total of 11 patients were identified for inclusion. The median cangrelor dose was 0.5 mu g/kg/min (interquartile range = 0.5-0.5) and was maintained in 7 of 11 patients. Doses ranged from 0.25 to 2 mu g/kg/min during therapy, and 81.6% of VerifyNow results assessed were within goal range (<= 208 P2Y(12) reaction units). Bleeding complications during therapy occurred in 3 patients, all of whom were receiving concomitant heparin infusions, and no stent thrombosis was reported. Conclusion and Relevance: Low-dose cangrelor may represent an effective option for bridging antiplatelet therapy in patients with coronary stents. This study demonstrated that the majority of patients received adequate platelet inhibition without any incidence of stent thrombosis on 0.5 mu g/kg/min using the VerifyNow assay to monitor platelet inhibition, which represents a lower dose than previously reported in the literature.