An analysis of antiplatelet therapies used during percutaneous coronary intervention (PCI) has concluded that cangrelor (Kengreal) is effective at reducing ischaemic events without increasing bleeding events when compared to glycoprotein IIB/IIIA inhibitors.
The finding was presented by Charan Yerasi, interventional cardiology fellow at Medstar Washington Hospital Center, Washington, DC, USA, delivered during a live abstract session at the Cardiovascular Research Technologies meeting (CRT 21 Virtual, 13 February–24 April). Yerasi commented that the findings point to a need for future randomised studies comparing cangrelor and glycoprotein IIB, due to the incidence of bleeding associated with the latter.
“We all know that platelets play a key role in ischaemic complications during and after PCI, and there have been many drugs developed,” said Yerasi in the introduction to his presentation. “Unlike other agents, [cangrelor] has a very rapid onset of action with vast return of platelet function after cessation,” he continued.
The CHAMPION trials have previously shown that cangrelor significantly decreases ischaemic events when compared to clopidogrel with no significant difference in major bleeding rates, Yerasi noted, commenting that in sub-group analysis, the rates of stent thrombosis and myocardial infarction were significantly lower in the cangrelor group. “This made cangrelor very attractive to use in high thrombus states, such as acute coronary syndromes,” he said.
Yerasi added that while glycoprotein IIB has also shown benefit in reducing ischaemic events, an increase in major bleeding events has also been observed. When comparing cangrelor to glycoprotein IIB, an exploratory analysis from the CHAMPION trials found that cangrelor is noninferior for ischaemic events, although major bleeding rates were significantly lower.
To explore this finding further, Yerasi and colleagues at the Medstar Washington Hospital Center performed a retrospective single centre study including all patients who underwent PCI at the institution and who received either cangrelor or glycoprotein IIB as an adjunct to antiplatelet therapy during the procedure.
Ischaemic events such as all-cause mortality, cardiac death, non-procedural Q-wave myocardial infarction (MI), and target vessel revascularisation were compared, alongside major bleeding events.
The study team identified 2,072 patients who received antiplatelet therapy during PCI, 77% (1,494) received glycoprotein IIB and 23% (478) received cangrelor. The study population had a mean age of 61 years, the majority of whom (66%) presented with acute coronary syndrome, while 9% presented with cardiogenic shock.
Turning to the results, Yerasi explained that there was no major difference between cangrelor and glycoprotein IIB in terms of ischaemic events, all-cause mortality, cardiac death, myocardial infarction, coronary artery bypass grafting (CABG), and stroke stent thrombosis. “However,” he continued, “if you look at the other events such as length-of-stay and ICU [intensive care unit] days, both were significantly lower in cangrelor when compared to glycoprotein IIb/IIIa inhibitors.” Bleeding events were also less frequent among the patients receiving cangrelor, he revealed.
The study team also carried out regression analysis to identify the predictors of bleeding. This revealed that the patients receiving cangrelor were noted to have significantly lower major bleeding rates (odds ratio [OR]=0.23) and that patients who presented with acute coronary syndrome, cardiogenic shock, and baseline haematocrit lower were noted to have a higher bleeding rate.
Yerasi noted that there are a number of limitations to the study, including the potential for selection bias and differences in the baseline characteristics between the two study groups. This is among the reasons, he said, that the differences in the two approaches should be explored in a randomised trial.
Summing up the findings, Yerasi said: “Balancing ischaemic and bleeding risk are very important during PCI. Our real-world analysis—the first ever published—showed that cangrelor is effective at reducing ischaemic events, without increasing bleeding events when compared to glycoprotein IIB. It also reduces length of stay, [length of] ICU stay, and overall vascular complications.”