Comparison of Outcomes in Patients Requiring Mechanical Circulatory Support Who Received Cangrelor in Addition to Anticoagulation Versus Anticoagulation Alone
Research article published in Journal of cardiothoracic and vascular anesthesia (2024)
Abstract
OBJECTIVES: To evaluate the safety of cangrelor administered concurrently with heparin or bivalirudin in patients on mechanical circulatory support. DESIGN: A single-center, retrospective cohort study of adult patients consecutively admitted between January 2016 and October 2020. SETTING: A tertiary medical center. PARTICIPANTS: Adult patients admitted to the cardiovascular intensive care unit put on mechanical circulatory support for acute myocardial infarction (AMI) or non-AMI indications. Patients who received cangrelor underwent percutaneous coronary intervention with stenting during the index event or within the last year. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the incidence of major bleeding, defined by the Extracorporeal Life Support Organization criteria, in patients with mechanical circulatory support receiving cangrelor plus anticoagulation with heparin or bivalirudin with or without aspirin versus patients who did not receive cangrelor. Sixty-eight patients were included in the study. Twenty-nine patients received cangrelor, and 39 did not. Cangrelor was not associated with an increase in major bleeding; however, the CI was wide (adjusted hazard ratio 1.93, 95% CI 0.61-6.11; p = 0.262). CONCLUSIONS: Patients receiving cangrelor did not appear to be at higher risk of major bleeding compared to patients not receiving cangrelor. Larger trials should be conducted to better evaluate the safety of cangrelor in patients with mechanical circulatory support.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
In a retrospective single-center cohort of 68 adults on mechanical circulatory support, adding cangrelor to heparin or bivalirudin anticoagulation did not significantly raise major bleeding versus anticoagulation alone (adjusted HR 1.93, 95% CI 0.61-6.11).
Why This Matters for Hirudotherapy
This retrospective single-center cohort study evaluated the safety of adding cangrelor to anticoagulation (heparin or bivalirudin) in 68 patients on mechanical circulatory support, finding no significant increase in major bleeding with cangrelor use, though confidence intervals were wide. The study is a comparative pharmacology/safety analysis focused on antiplatelet-anticoagulant combinations in critically ill cardiac patients. Bivalirudin appears as one comparator anticoagulant. Bivalirudin (formerly Hirulog) is a synthetic peptide anticoagulant designed partly on the C-terminal sequence of hirudin, the anticoagulant of the medicinal leech (Maraganore et al., 1990); this paper studies the drug, not leech therapy.
Citation
Reference (Vancouver style)
Martin TC, Duewell BE, Juul JJ, Rinka JRG, Rein L, Feih JT. Comparison of Outcomes in Patients Requiring Mechanical Circulatory Support Who Received Cangrelor in Addition to Anticoagulation Versus Anticoagulation Alone. J Cardiothorac Vasc Anesth. 2024;38(6):1328-1336. doi:10.1053/j.jvca.2024.02.039. PMID: 38521630
Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.
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