Cangrelor a potential treatment for PCI patients unable to take oral meds
Patients undergoing urgent/emergent percutaneous coronary intervention (PCI) and unable to take oral medications are good candidates for treatment with cangrelor, according to a new meta-analysis.
A pooled analysis of three clinical trials, resulting in a cumulative sample of 24,910 patients, showed that after 48 hours, cangrelor reduced the odds of the primary composite outcome (death, myocardial infarction, ischaemia-driven revascularization or stent thrombosis) by 19 percent (3.8 percent for cangrelor vs 4.7 percent for control; odds ratio [OR], 0.81; 95 percent CI, 0.71–0.91; p=0.007).
Similarly, cangrelor decreased the risk of the secondary outcome of stent thrombosis (OR, 0.59; 0.43–0.80; p=0.0008) and of the secondary composite outcome of death, myocardial infarction and ischaemia-driven revascularization (OR, 0.81; 0.71–0.92; p=0.0014).
The same was true for the risk of the composite of death, Q-wave myocardial infarction and stent thrombosis (OR, 0.63; 0.49–0.81; p=0.0002).
Taking each component of the primary composite outcome independently, cangrelor similarly resulted in significantly reduced odds of ischaemia-driven revascularization (OR, 0.71; 0.52–0.98; p=0.0363) and myocardial infarction (OR, 0.85; 0.74–0.97; p=0.0182).
In contrast, while the death count was lower in those who were on cangrelor medication (0.3 percent vs 0.4 percent), there was no significant difference in risk (OR, 0.73; 0.47–1.15; p=0.1694).
Cangrelor was also relatively safe and well-tolerated, despite a potential side-effect of over-inhibition of the platelet P2Y12 pathway, said researchers. The clinical benefits associated with cangrelor was not hampered by increased risks of severe bleeding and moderate bleeding, or the need for blood transfusion.