Safety and Efficacy of Periprocedural Bridging With Cangrelor Versus Eptifibatide

Abstract

:Patients with percutaneous coronary interventions undergoing procedures often require interruptions in their dual antiplatelet therapy. Periprocedural bridging is considered for patients at high thrombotic risk using intravenous cangrelor, a reversible P2Y12 inhibitor with a short half-life, or eptifibatide, a glycoprotein IIb/IIIa inhibitor, with a slightly longer half-life but less costly alternative. This study aims to assess the safety and efficacy of cangrelor compared with eptifibatide when used in a periprocedural setting. The primary outcome of this retrospective cohort study was the incidence of bleeding events defined by the global use of strategies to open occluded coronary arteries criteria, and the secondary outcomes include the transfusion requirements, inpatient major cardiac adverse events, and cost savings per patient. A total of 75 patients were included who were bridged to procedures (cangrelor, n = 50; eptifibatide, n = 25). There were no significant differences in overall bleeding events defined by global use of strategies to open occluded coronary arteries criteria: mild bleeding [8% (n= 4) vs. 8% (n= 2); P = 0.68], moderate bleeding [28% (n = 14) vs. 48% (n = 12); P = 0.07), and severe bleeding [8% (n = 4) vs. 8% (n = 2); P = 0.25] between cangrelor and eptifibatide. The composite inpatient major cardiac adverse events were also similar between cangrelor and eptifibatide [10% (n = 10) vs. 8% (n = 8); P = 0.78]. The average cost savings per each cangrelor patient on the equivalent duration of eptifibatide was calculated out to be $5824 per patient. Cangrelor and eptifibatide were similar in terms of safety and efficacy when used as a bridge in patients with recent coronary stents, but considerable cost savings could be made if cangrelor was substituted for by eptifibatide in select patients. Further studies are needed to determine its applicability specifically in patients at high thrombotic and hemorrhagic risk.

Perioperative Antiplatelet Bridging With Cangrelor: A Cohort Study and Narrative Review

“…8 Retrospective studies of cangrelor bridging for NCS report either no bleeding or minor procedural bleeding (Table 4), suggesting that this is a safe approach to perioperative platelet inhibition. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]…”

“…Similarly, the BRIDGE trial reported a low incidence of preoperative ischemic events, and retrospective studies of cangrelor bridging for NCS report a low incidence of perioperative MACE (Table 4). 8,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Thus, cangrelor bridging appears to be an effective approach for mitigating the risk of perioperative MACE.…”

“…Patient selection and bridging practices vary somewhat across studies, though the literature consistently reports a low incidence of perioperative bleeding and ischemic events. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Although an international consensus statement provides guidance on using cangrelor for off-label perioperative bridging, there remain areas of uncertainty. 10 It is not fully known whether the VerifyNow PRUTest of platelet reactivity can be used to guide timing of cangrelor after oral washout.…”

Eptifibatide, an Older Therapeutic Peptide with New Indications: From Clinical Pharmacology to Everyday Clinical Practice

“…It should be considered in patients with renal insufficiency, as clearance of eptifibatide is influenced by renal function [ 98 ]. Moreover, a study by Yun et al from 2019 showed that cangrelor and eptifibatide were similar in terms of overall bleeding events and major inpatient cardiac adverse events [ 100 ].…”

Efficacy, Safety, and Role of Antiplatelet Drugs in the Management of Acute Coronary Syndrome: A Comprehensive Review of Literature

“…A study comparing cangrelor and eptifibatide discovered that both drugs have comparable safety and efficacy as a bridge treatment for patients with recent coronary stents. Additionally, substituting cangrelor with eptifibatide in select patients could result in cost savings [ 51 ].…”