Clinical use of cangrelor: a real-world multicenter experience from South Italy

Pepe, Martino; Larosa, Claudio; Cirillo, Plinio; Carulli, Eugenio; Forleo, Cinzia; Nestola, Palma Luisa; Ercolano, Vincenzo; D'Alessandro, Pasquale; Giordano, Arturo; Biondi‐Zoccai, Giuseppe; Moscarelli, Marco; Palmiotto, Angela; Esposito, Giovanni; Favale, Stefano

doi:10.23736/s0031-0808.21.04437-2

Cited by 3 publications

(6 citation statements)

References 33 publications

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“…Our data confirmed that Cangrelor is more often used in clinically unstable patients such as those with CS and/or treated with inotropic drugs and/or with CCA at presentation and/or intubated and, concordantly, in those with a severely reduced LVEF. This is in line with previous evidence 23 , 24 and can be partly explained by the impracticability of the oral route or the uncertainty of intestinal absorption in patients with high-risk clinical presentation, both limitations easily overcome by the intravenous administration of Cangrelor. Moreover, our analysis suggests the possible preference towards Cangrelor in patients with higher risk of bleeding as indicated by the higher rate of patients with history of previous bleeding and the higher (despite at the limit for significance) PRECISE DAPT score in the Cangrelor group.…”

Section: Discussionsupporting

confidence: 90%

Comparative effectiveness of Cangrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: an observational investigation from the M.O.Ca. registry

Pepe

Carulli

Larosa

et al. 2023

Sci Rep

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Cangrelor, the first intravenous P2Y12 inhibitor (P2Y12-I), has been approved on the basis of three large RCTs from the CHAMPION program which nevertheless have been criticized for the low bleeding risk of the enrolled patients, the large quote of chronic coronary syndromes, and the use of Clopidogrel as control arm even in the setting of acute coronary syndromes (ACS). We sought to investigate, in the setting of ACS, the comparative performance of Cangrelor in terms of in-hospital ischemic and haemorrhagic outcomes compared with the current gold-standard of oral P2Y12-I. The study retrospectively enrolled 686 consecutive patients admitted to the Divisions of Cardiology of Policlinico of Bari and L. Bonomo Hospital of Andria for ACS and treated with percutaneous coronary intervention. The study population was divided according to the P2Y12-I treatment strategy in two groups: patients given an oral P2Y12-I and patients receiving Cangrelor in the cath lab followed by an oral P2Y12-I. Clinical endpoints included death, ischemic and bleeding events occurring during hospital stay. Cangrelor treated patients presented higher clinical risk profile at presentation and faced higher death rate. However, after PS matching, in-hospital mortality resulted comparable between the groups and Cangrelor use was associated with reduced in-hospital definite stent thrombosis (p = 0.03). Data from our real-world registry highlight that, in the setting of ACS, Cangrelor is prevalently used in patients with very challenging clinical presentations. The adjusted analysis provides for the first time promising data on stent thrombosis reduction associated with Cangrelor use.

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Section: Discussionsupporting

confidence: 90%

Comparative effectiveness of Cangrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: an observational investigation from the M.O.Ca. registry

Pepe

Carulli

Larosa

et al. 2023

Sci Rep

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“…Our data con rmed that Cangrelor is more often used in clinically unstable patients such as those with CS and/or treated with inotropic drugs and/or with CCA at presentation and/or intubated and, concordantly, in those with a severely reduced LVEF. This is in line with previous evidence 23,24 and can be partly explained by the impracticability of the oral route or the uncertainty of intestinal absorption in patients with high-risk clinical presentation, both limitations easily overcome by the intravenous administration of Cangrelor. Moreover, our analysis suggests the possible preference towards Cangrelor in patients with higher risk of bleeding as indicated by the higher rate of patients with history of previous bleeding and the higher (despite at the limit for signi cance) PRECISE DAPT score in the Cangrelor group.…”

Section: Discussionsupporting

confidence: 90%

“…Notwithstanding the randomized nature, the CHAMPION studies present some limitations which have been widely recognized over time. Firstly the CHAMPION population was at relatively low ischemic risk since more than 30% of patients were addressed to PCI because ofCCS 25 , which does not re ect the prevalent clinical setting in which the drug has been used, so far, in the real-world as suggested by several recent registries 23,24,26 .…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of Cangrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: Insights from the multicenter M.O.Ca. registry

Pepe

Carulli

Larosa

et al. 2023

Preprint

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Background: Cangrelor, the first intravenous P2Y12 inhibitor (P2Y12-I), has been approved on the basis of three large RCTs from the CHAMPION program which nevertheless have been criticized for the low bleeding risk of the enrolled patients, the large quote of chronic coronary syndromes (CCS), and the use of Clopidogrel as control arm even in the setting of acute coronary syndromes (ACS). We sought to investigate, in the setting of ACS, the comparative performance of Cangrelor in terms of in-hospital ischemic and haemorrhagic outcomes compared with the current gold-standard of oral P2Y12-I. Methods: The study retrospectively enrolled 686 consecutive patients admitted to the Divisions of Cardiology of Policlinico of Bari and L. Bonomo Hospital of Andria for ACS and treated with percutaneous coronary intervention (PCI). The study population was divided according to the P2Y12-I treatment strategy in two groups: patients given an oral P2Y12-I and patients receiving Cangrelor in the CathLab followed by an oral P2Y12-I. Clinical endpoints included death, ischemic and bleeding events occurring during hospital stay. Results: Cangrelor treated patients presented higher clinical risk profile at presentation and faced higher death rate. However, after PS matching, in-hospital mortality resulted comparable between the groups and Cangrelor use was associated with reduced in-hospital definite stent thrombosis (p=0.03). Conclusions: Data from our real-world registry highlight that, in the setting of ACS, Cangrelor is prevalently used in patients with very challenging clinical presentations. The adjusted analysis provides for the first time promising data on stent thrombosis reduction associated with Cangrelor use.

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“…Trials that led to the cangrelor approval were mainly performed on patients with non‐ST‐segment elevation myocardial infarction (NSTEMI) and unstable angina (UA), 19–21 but cangrelor has increasingly been used in STEMI in real‐life practice 22–25 …”

Section: Introductionmentioning

confidence: 99%

“…18 Trials that led to the cangrelor approval were mainly performed on patients with non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA), [19][20][21] but cangrelor has increasingly been used in STEMI in real-life practice. [22][23][24][25] European Medicines Agency (EMA) suggested to the marketing authorization holder of cangrelor (Chiesi) to perform a postauthorization nonimposed safety study (Category 3) 26 focused on ACS,…”

Section: Introductionmentioning

confidence: 99%

Use of cangrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Study design and interim analysis of the ARCANGELO study

Luca

Calabrò

Chirillo

et al. 2022

Clinical Cardiology

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Background:The itAlian pRospective Study on CANGrELOr (ARCANGELO) was aimed to assess the safety of using cangrelor during percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) in the daily practice. Hypothesis:The safety of cangrelor after the transition to oral P2Y12 inhibitors was evaluated as the incidence of bleeding outcomes in the 30 days following PCI according to postauthorization safety study guidelines.Methods: Adults with ACS who were treated with cangrelor in one of the 28 centers involved in the study. Patients who consented to participate were followed in the 30 days following their PCI. Bleedings (Bleeding Academic Research Consortium [BARC] classification), major adverse cardiac events (MACEs), and adverse events were recorded. The interim results at two-thirds of the enrollment period are presented.Results: A total of 17 bleedings were observed in the 320 patients who completed the study at this stage. All bleedings were classified as BARC Type 1-2, except for one case of Type 3a (vessel puncture site hematoma). Four patients experienced MACEs (2 acute myocardial infarctions, 1 sudden cardiac death, 1 noncardiovascular death due to respiratory distress, and multiorgan failure). None of the bleedings was rated as related to cangrelor. Conclusions:The interim results of the ARCANGELO study provide a preliminary confirmation that the use of cangrelor on patients with ACS undergoing PCI is not associated with severe bleedings.

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Clinical use of cangrelor: a real-world multicenter experience from South Italy

Cited by 3 publications

References 33 publications

Comparative effectiveness of Cangrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: an observational investigation from the M.O.Ca. registry

Comparative effectiveness of Cangrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: an observational investigation from the M.O.Ca. registry

Comparative effectiveness of Cangrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: Insights from the multicenter M.O.Ca. registry

Use of cangrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Study design and interim analysis of the ARCANGELO study

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