Impact of Intravenous P2Y12-Receptor Inhibition with Cangrelor in Patients Presenting with Acute Coronary Syndrome and Cardiogenic Shock - a Case Series.

Abstract

BACKGROUND/AIMS:

Patients with acute coronary syndromes (ACS) presenting with cardiogenic shock (CS) are at particular risk for death and adverse cardiac events. Impaired effects and absorption of oral P2Y12-receptor inhibitors due to decreased organ hypoperfusion or hypothermia and challenges regarding oral administration contribute to this risk. We report a single center experience regarding the use of intravenous P2Y12-receptor inhibitor cangrelor in patients with CS treated with percutaneous coronary intervention (PCI).

METHODS:

Twelve patients with ACS and CS undergoing PCI, not pretreated with oral P2Y12-receptor inhibitors, were treated with cangrelor. Platelet inhibition was assessed by multiple electrode aggregometry (MEA) before and after PCI, immediately and 2 hours after stopping the cangrelor infusion.

RESULTS:

Nine patients recovered from their cardiogenic shock, 3 patients died. Platelet reactivity decreased from 65.9 (SD 41.0) U before PCI to 15.8 (SD 10.8) U after PCI, 13.4 (SD 7.7) U at the end of infusion and 33.8 (SD 19.9) 2 hours after stopping the cangrelor infusion. There was no non-responder under cangrelor infusion (MEA < 46 U).

CONCLUSIONS:

Due to its favorable PK/PD profile, cangrelor overcomes problems with reduced absorption and effects of oral P2Y12-receptor inhibitors and should be considered for periprocedural treatment of patients with CS.

• Authors: Michal Droppa, Oliver Borst, Dominik Rath, Karin Müller, Meinrad Gawaz, Deepak L Bhatt, Tobia Geisler
• Journal: Cellular physiology and biochemistry : international journal of experimental cellular physiology, biochemistry, and pharmacology (Cell Physiol Biochem) Vol. 42 Issue 4 Pg. 1336-1341 ( 2017) ISSN: 1421-9778 [Electronic] Germany
• PMID: 28700987 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2017 The Author(s). Published by S. Karger AG, Basel.

Chemical References

• Cardiotonic Agents
• Platelet Aggregation Inhibitors
• Purinergic P2Y Receptor Antagonists
• Receptors, Purinergic P2Y
• Adenosine Monophosphate
• cangrelor

Topics

• Acute Coronary Syndrome (blood, mortality, physiopathology, therapy)
• Adenosine Monophosphate (analogs & derivatives, therapeutic use)
• Administration, Intravenous
• Aged
• Cardiotonic Agents (therapeutic use)
• Female
• Gene Expression
• Humans
• Male
• Middle Aged
• Percutaneous Coronary Intervention
• Platelet Aggregation (drug effects)
• Platelet Aggregation Inhibitors (therapeutic use)
• Purinergic P2Y Receptor Antagonists (therapeutic use)
• Receptors, Purinergic P2Y (genetics, metabolism)
• Shock, Cardiogenic (blood, mortality, physiopathology, therapy)
• Survival Analysis