title: Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery.
abstract: OBJECTIVE
  Oral P2Y₁₂ platelet receptor inhibitors are a cornerstone of reducing complications in patients with acute coronary syndromes or coronary stents. Guidelines advocate discontinuing treatment with P2Y₁₂ platelet receptor inhibitors before surgery. Cangrelor, a short-acting, reversible, intravenously administered P2Y₁₂ platelet inhibitor is effective in achieving appropriate platelet inhibition in patients who are awaiting coronary artery bypass grafting (CABG) and require P2Y₁₂ inhibition. The objective of this study was to assess the effects of preoperative cangrelor on the incidence of perioperative complications, which are currently unknown.
  
  
  METHODS
  Patients (n = 210) requiring preoperative clinical administration of thienopyridine therapy were randomized in a multicenter, double-blinded study to receive cangrelor or placebo while awaiting CABG after discontinuation of the thienopyridine. Optimal platelet reactivity, which was defined as <240 P2Y₁₂ platelet reaction units, was measured with serial point-of-care testing (VerifyNow). Pre- and postoperative outcomes, bleeding values, and transfusion rates were compared. To quantify potential risk factors for bleeding, we developed a multivariate logistic model.
  
  
  RESULTS
  The differences between the groups in bleeding and perioperative transfusion rates were not significantly different. The rate of CABG-related bleeding was 11.8% (12/102) in cangrelor-treated patients and 10.4% (10/96) in the placebo group (P = .763). Transfusion rates for the groups were similar. Serious postoperative adverse events for the cangrelor and placebo groups were 7.8% (8/102) and 5.2% (5/96), respectively (P = .454).
  
  
  CONCLUSIONS
  Compared with placebo, bridging patients with cangrelor prior to CABG effectively maintains platelet inhibition without increasing post-CABG complications, including bleeding and the need for transfusions. These data suggest cangrelor treatment is a potential strategy for bridging patients requiring P2Y₁₂ receptor inhibition while they await surgery.
authors.affiliation: Department of Surgery (Cardiothoracic), Akron City Hospital, Northeast Ohio Medical University, Akron, OH 44309, USA. Michael.firstenberg@osumc.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Firstenberg
authors.forename: Cornelius M
authors.initials: CM
authors.lastname: Dyke
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.forename: Chandrashekar
authors.initials: C
authors.lastname: Ramaiahm
authors.forename: Matthew
authors.initials: M
authors.lastname: Price
authors.forename: Miroslav
authors.initials: M
authors.lastname: Brtko
authors.forename: Ian
authors.initials: I
authors.lastname: Welsby
authors.forename: Harish
authors.initials: H
authors.lastname: Chandna
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Michele
authors.initials: M
authors.lastname: Voeltz
authors.forename: Pradyumna
authors.initials: P
authors.lastname: Tummala
authors.forename: Martin
authors.initials: M
authors.lastname: Hutyra
authors.forename: Steven V
authors.initials: SV
authors.lastname: Manoukian
authors.forename: Jayne
authors.initials: J
authors.lastname: Prats
authors.forename: Meredith
authors.initials: M
authors.lastname: Todd
authors.forename: Tiepu
authors.initials: T
authors.lastname: Liu
authors.forename: Nicholas
authors.initials: N
authors.lastname: Chronos
authors.forename: Markus
authors.initials: M
authors.lastname: Dietrich
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.forename: Louis A
authors.initials: LA
authors.lastname: Cannon
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topo
mesh_terms: D000249:Adenosine Monophosphate / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015990:Placebo Effect; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control*; D011292:Premedication / Q000706:statistics & numerical data*; D015995:Prevalence; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage; D011725:Pyridines / Q000008:administration & dosage*; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D011725:Pyridines; C446540:thienopyridine; D000249:Adenosine Monophosphate; C117446:cangrelor