title: Periprocedural platelet inhibition with cangrelor in P2Y12-inhibitor naïve patients with acute coronary syndromes - A matched-control pharmacodynamic comparison in real-world patients.
abstract: BACKGROUND
  Effective inhibition of platelet aggregation during PCI in high risk patients with ACS is of utmost importance. The new intravenous short acting P2Y12-receptor inhibitor cangrelor is available for use in PCI-treated patients. We aimed to study platelet inhibition during treatment with cangrelor and transition phase with oral P2Y12-receptor inhibitors in patients with acute coronary syndromes (ACS).
  
  
  METHODS
  Cangrelor was administered during PCI to 21 P2Y12-inhibitor naïve patients with ACS. Patients received a loading dose of ticagrelor at the time of procedure or prasugrel 30min before end of the cangrelor infusion. Platelet inhibition was measured by multiple electrode aggregometry (MEA) and thromboelastography (TEG), before and after PCI, immediately and 2h after stopping the infusion. Platelet inhibition after PCI was compared to a matched cohort of patients treated with oral P2Y12-inibitors only.
  
  
  RESULTS
  There was a significant reduction of platelet reactivity measured by MEA-ADP from 46.7U to 17.9U and by TEG MA ADP from 43.1mm to 22.0mm before infusion and after PCI respectively (p<0.001). There was also sustained platelet inhibition after stopping of cangrelor infusion and 2h later. Significant higher platelet inhibition was observed at the end of PCI in comparison to control cohort without cangrelor (MEA 17.9U vs. 54.2U, p=0.001).
  
  
  CONCLUSIONS
  We demonstrate significantly improved platelet inhibition during PCI in ACS patients treated with cangrelor in comparison to early treatment with potent oral P2Y12-inhibitors. Cangrelor should be considered for periprocedural treatment of high risk patients with acute coronary syndrome.
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Otfried-Mueller-Strasse 10, 72076 Tübingen, Germany. Electronic address: mdroppa@gmail.com.
authors: Michal
authors: M
authors: Droppa
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Otfried-Mueller-Strasse 10, 72076 Tübingen, Germany. Electronic address: Pascal.Spahn@med.uni-tuebingen.de.
authors: Pascal
authors: P
authors: Spahn
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Otfried-Mueller-Strasse 10, 72076 Tübingen, Germany. Electronic address: khalidtakhgiriev@gmail.com.
authors: Khalid
authors: K
authors: Takhgiriev
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Otfried-Mueller-Strasse 10, 72076 Tübingen, Germany. Electronic address: k.mueller@med.uni-tuebingen.de.
authors: Karin A L
authors: KAL
authors: Müller
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Otfried-Mueller-Strasse 10, 72076 Tübingen, Germany. Electronic address: Ahmed.Alboji@med.uni-tuebingen.de.
authors: Ahmed
authors: A
authors: Alboji
authors: Department of Anesthesiology and Intensive Care Medicine, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany. Electronic address: Andreas.Straub@med.uni-tuebingen.de.
authors: Andreas
authors: A
authors: Straub
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Otfried-Mueller-Strasse 10, 72076 Tübingen, Germany. Electronic address: Dominik.Rath@med.uni-tuebingen.de.
authors: Dominik
authors: D
authors: Rath
authors: Department of Internal Medicine, Gyeongsang National University, School of Medicine and Cardiovascular Center, Changwon Gyeongsang National University Hospital, Changwon-si, Gyeongsangnam-do, Republic of Korea. Electronic address: goodoctor@naver.com.
authors: Young-Hoon
authors: YH
authors: Jeong
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Otfried-Mueller-Strasse 10, 72076 Tübingen, Germany. Electronic address: Meinrad.Gawaz@med.uni-tuebingen.de.
authors: Meinrad
authors: M
authors: Gawaz
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Otfried-Mueller-Strasse 10, 72076 Tübingen, Germany. Electronic address: tobias.geisler@email.de.
authors: Tobias
authors: T
authors: Geisler
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000628:therapy; D000249:Adenosine Monophosphate / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D061605:Administration, Intravenous; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D019990:Perioperative Care / Q000379:methods; D010974:Platelet Aggregation / Q000187:drug effects*; D010979:Platelet Function Tests / Q000379:methods; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000493:pharmacokinetics; D016896:Treatment Outcome
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D000249:Adenosine Monophosphate; C117446:cangrelor
keywords: Acute coronary syndrome; Cangrelor; Multiple electrode aggregometry; Platelet inhibition; Thromboelastography