According to research published in the Journal of the American Medical Association, among patients who discontinue thienopyridine therapy prior to cardiac surgery, the use of cangrelor compared with placebo resulted in a higher rate of maintenance of platelet inhibition.

Researchers conducted a double-blind, placebo-controlled trial to evaluate the use of cangrelor, an intravenous, reversible P2Y12 platelet inhibitor for bridging thienopyridine-treated patients to coronary artery bypass grafting (CABG) surgery. The study involved a total of 210 patients with an acute coronary syndrome (ACS) or treated with a coronary stent and receiving a thienopyridine awaiting CABG surgery to receive either cangrelor or placebo. Thienopyridines were stopped a week prior to surgery, and patients were administered cangrelor or placebo for at least 48 hours, which was discontinued 1 to 6 hours before CABG surgery. The primary efficacy end point was platelet reactivity (measured in P2Y12 reaction units [PRUs]), assessed daily. The main safety end point was excessive CABG surgery–related bleeding.

The researchers reported that a greater proportion of patients treated with cangrelor had low levels of platelet reactivity throughout the entire treatment period compared with placebo (98.8% (83 of 84) vs 19.0% (16 of 84); relative risk [RR], 5.2 [95% CI, 3.3-8.1] P < p.001). However, excessive CABG surgery–related bleeding occurred in 11.8% (12 of 102) vs 10.4% (10 of 96) in the cangrelor and placebo groups, respectively although this was not statistically significantly different between the groups (RR, 1.1 [95% CI, 0.5-2.5] P = 0.763). Additionally, there were no significant differences in major bleeding prior to CABG surgery, although minor bleeding episodes were numerically higher with cangrelor.

The researchers conclude that cangrelor may provide a useful option for high-risk patients waiting for cardiac surgery who require prolonged platelet P2Y12 inhibition after thienopyridine discontinuation.