Intravenous Platelet Blockade with Cangrelor during PCI

Bhatt, Deepak L.; Lincoff, A. Michael; Gibson, C. Michael; Stone, Gregg W.; McNulty, Steven E.; Montalescot, Gilles; Kleiman, Neal S.; Goodman, Shaun G.; White, Harvey D.; Mahaffey, Kenneth W.; Pollack, Charles V.; Manoukian, Steven V.; Widimský, Petr; Chew, Derek P.; Cura, Fernando; Manukov, Ivan H; Toušek, František; Jafar, M. Zubair; Arneja, Jaspal; Skerjanec, Simona; Harrington, Robert A.

doi:10.1056/nejmoa0908629

Cited by 570 publications

(356 citation statements)

References 25 publications

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“…This finding may be due in part to the more critical hemodynamic conditions of these patients that are associated, mainly in cardiogenic shock, with a significant reduction of the absorption of drugs from the intestine [27], in part to the difficulty to give them the needed antiplatelet therapy, mandatory after stent implantation. New intravenous antiplatelet drugs seem promising in reducing thrombotic events related to PCI [28] and then, if these data are confirmed, they could overcome these issues. Our study has some important limitations: first, it is a retrospective analysis and is therefore subject to the limitations of such analyses.…”

Section: Discussionmentioning

confidence: 99%

Endotracheal intubation and outcome in high-risk patients with acute myocardial infarction undergoing primary angioplasty

Tomassini¹,

Gagnor²,

Montali³

et al. 2014

J Anesthesiol Clin Sci

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Background: Patients with acute myocardial infarction (AMI) who undergo endotracheal intubation (ETI) are at high risk for mortality, but the outcome of those patients submitted to primary angioplasty (PCI) has not yet clearly reported. Methods:We collected data about all consecutive patients with AMI within 12 hours who underwent primary PCI and analyzed clinical and procedural characteristics as well as in-hospital mortality of ETI compared to no-ETI patients. Results: From September 2001 to June 2010, 1251 patients underwent primary PCI and 99 (7.9%) of them underwent ETI. ETI patients were more likely to be hypertensive (76.8% vs 67.8%, p=0.003), diabetic 43.4% vs 17.9%, p<0.0001), resuscitated by cardiac arrest (68.7% vs 0.7%, p<0.0001), to present with cardiogenic shock (CS) (61.6% % vs 8.1%, p<0.0001), with a lower left ventricular ejection fraction (LVEF) (38.9±9.4% vs 48.9±9.2%, p<0.0001) and to be treated with intra-aortic balloon counterpulsation (IABP) (60.1% vs 15.4%, p<0.0001). The in-hospital mortality was higher in ETI patients (37.4% vs 4.3%, p<0.0001) and they were more likely to undergo stent thrombosis (3% vs 0.34%, p=0.006). After using the propensity score modelling. Considering the risk profile, ETI was associated to higher in hospital mortality in the patients at higher risk (39.8% vs 18.5%, p=0.003). Moreover, ETI was one of the most powerful predictors of in-hospital mortality at multivariate analysis (OR 37.04, 95% CI 6.0-228.45, p=0.0001). Conclusions: ETI was found to be an independent predictor of mortality in high-risk AMI patients undergoing primary angioplasty. The implications for current clinical care remained undefined.

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Section: Discussionmentioning

confidence: 99%

Endotracheal intubation and outcome in high-risk patients with acute myocardial infarction undergoing primary angioplasty

Tomassini¹,

Gagnor²,

Montali³

et al. 2014

J Anesthesiol Clin Sci

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“…On the basis of data supporting the feasibility of the use of cangrelor in patients undergoing PCI in need of antiplatelet therapy, cangrelor's phase III programme, two parallel CHAMPION studies (Cangrelor versus standard tHerapy to Achieve optimal Management of Platelet InhibitiON) were initiated, the CHAMPION-PCI and CHAMPION-PLATFORM studies (Table 1) [51,52]. Despite its promise, the results of both studies failed to demonstrate that cangrelor was superior to clopidogrel in terms of the primary composite endpoints at both 48 hours and at 30 days [51,52].…”

Section: Phase IIImentioning

confidence: 99%

“…Despite its promise, the results of both studies failed to demonstrate that cangrelor was superior to clopidogrel in terms of the primary composite endpoints at both 48 hours and at 30 days [51,52]. Discouraging trends in results led to premature termination of both studies.…”

Section: Phase IIImentioning

confidence: 99%

“…It was also identified that many patients had one or even no cardiac markers assessed, or had increasing cardiac markers, before PCI resulting in an inability to detect PCI-related MI beyond clinical judgement. Hence, this may explain the relatively better results of cangrelor in patients with stable angina, in whom cardiac markers prior to PCI tend to be normal [51,52]. The plausibility of inadequate MI definition being a source for poor cangrelor results in CHAMPION-PCI and CHAMPION-PLATFORM was made higher when a retrospective analysis used the Universal MI definition to yield a lower number of PCI-related MI events [53].…”

Section: Phase IIImentioning

confidence: 99%

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Cangrelor for the management and prevention of arterial thrombosis

Storey

Sinha

2016

Expert Review of Cardiovascular Therapy

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SUMMARYCangrelor is an intravenous, reversibly-binding platelet P2Y 12 receptor antagonist with ultra-rapid onset and offset of action. It is approved in Europe and United States for use in patients undergoing percutaneous coronary intervention, a setting in which it has proven superiority to initial treatment with clopidogrel. Preliminary clinical evidence suggests it would also be a favourable option in bridging patients from discontinuation of oral antiplatelet therapy to the time of major surgery. This review describes the background for the development of cangrelor, the biology, pharmacology and clinical evidence supporting its use, and its likely position in the future.

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“…Cangrelor, the only intravenously administered P2Y12 inhibitor, is characterized by rapid onset and offset, with platelets regaining normal reactivity within 30 to 60 minutes of cessation,3 making it an attractive treatment for patients undergoing procedures. Trials examining its routine use compared with clopidogrel showed that cangrelor improved outcomes when used during PCI, and reduced the risk of stent thrombosis and death among patients who received it periprocedurally 10, 11…”

Section: Introductionmentioning

confidence: 99%