Periprocedural platelet inhibition with cangrelor in P2Y₁₂-inhibitor naïve patients with acute coronary syndromes — A matched-control pharmacodynamic comparison in real-world patients

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• 作者：Michal Droppa^a ; ¹ ; ^{mdroppa@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Pascal Spahn^a ; ¹ ; ^{Pascal.Spahn@med.uni-tuebingen.de" class="auth_mail" title="E-mail the corresponding author} ; Khalid Takhgiriev^a ; ¹ ; ^{khalidtakhgiriev@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Karin A.L. Mü ; ller^a ; ¹ ; ^{k.mueller@med.uni-tuebingen.de" class="auth_mail" title="E-mail the corresponding author} ; Ahmed Alboji^a ; ¹ ; ^{Ahmed.Alboji@med.uni-tuebingen.de" class="auth_mail" title="E-mail the corresponding author} ; Andreas Straub^b ; ¹ ; ^{Andreas.Straub@med.uni-tuebingen.de" class="auth_mail" title="E-mail the corresponding author} ; Dominik Rath^a ; ¹ ; ^{Dominik.Rath@med.uni-tuebingen.de" class="auth_mail" title="E-mail the corresponding author} ; Young-Hoon Jeong^c ; ¹ ; ^{goodoctor@naver.com" class="auth_mail" title="E-mail the corresponding author} ; Meinrad Gawaz^a ; ¹ ; ^{Meinrad.Gawaz@med.uni-tuebingen.de" class="auth_mail" title="E-mail the corresponding author} ; Tobias Geisler^a ; ¹ ; ^{tobias.geisler@email.de" class="auth_mail" title="E-mail the corresponding author} ; ^{tobias.geisler@med.uni-tuebingen.de" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ACS ; acute coronary syndrome ; ADP ; adenosine diphosphate ; CAD ; coronary artery disease ; GFR ; glomerular filtration rate ; LV-EF ; left ventricular ejection fraction ; MEA ; multiple electrode aggregometry ; NSTE-ACS ; non-ST-elevation acute coronary syndrome ; NSTEMI ; non-ST-elevation myocardial infarction ; PCI ; percutaneous coronary intervention ; STEMI ; ST-elevation myocardial infarction ; TEG ; thromboelastography ; UA ; unstable angina pectoris
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 November 2016
• 年：2016
• 卷：223
• 期：Complete
• 页码：848-851
• 全文大小：360 K

文摘

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 30 min before end of the cangrelor infusion. Platelet inhibition was measured by multiple electrode aggregometry (MEA) and thromboelastography (TEG), before and after PCI, immediately and 2 h 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 46.7 U to 17.9 U and by TEG MA ADP from 43.1 mm to 22.0 mm before infusion and after PCI respectively (p < 0.001). There was also sustained platelet inhibition after stopping of cangrelor infusion and 2 h later. Significant higher platelet inhibition was observed at the end of PCI in comparison to control cohort without cangrelor (MEA 17.9 U vs. 54.2 U, p = 0.001).

Conclusion

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.