In:
The Heart Surgery Forum, Forum Multimedia Publishing LLC, Vol. 16, No. 2 ( 2015-04-03), p. 60-
Abstract:
〈 p 〉 〈 b 〉 Objective: 〈 /b 〉 Oral P2Y 〈 sub 〉 12 〈 /sub 〉 platelet receptor inhibitors are a cornerstone of reducing complications in patients with acute coronary syndromes or coronary stents. Guidelines advocate discontinuing treatment with P2Y 〈 sub 〉 12 〈 /sub 〉 platelet receptor inhibitors before surgery. Cangrelor, a short-acting, reversible, intravenously administered P2Y 〈 sub 〉 12 〈 /sub 〉 platelet inhibitor is effective in achieving appropriate platelet inhibition in patients who are awaiting coronary artery bypass grafting (CABG) and require P2Y 〈 sub 〉 12 〈 /sub 〉 inhibition. The objective of this study was to assess the effects of preoperative cangrelor on the incidence of perioperative complications, which are currently unknown. 〈 /p 〉 〈 p 〉 〈 b 〉 Methods: 〈 /b 〉 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 P2Y 〈 sub 〉 12 〈 /sub 〉 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. 〈 /p 〉 〈 p 〉 〈 b 〉 Results: 〈 /b 〉 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 ( 〈 i 〉 P 〈 /i 〉 = .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 ( 〈 i 〉 P 〈 /i 〉 = .454). 〈 /p 〉 〈 p 〉 〈 b 〉 Conclusions: 〈 /b 〉 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 P2Y 〈 sub 〉 12 〈 /sub 〉 receptor inhibition while they await surgery. 〈 /p 〉
Type of Medium:
Online Resource
ISSN:
1522-6662
,
1098-3511
DOI:
10.1532/HSF98.20121103
Language:
Unknown
Publisher:
Forum Multimedia Publishing LLC
Publication Date:
2015
detail.hit.zdb_id:
2069230-4
Permalink