Platelet Inhibition with Cangrelor in Patients Undergoing PCI
| Autor: | Robert A. Harrington, Gilles Montalescot, Steven McNulty, Kenneth W. Mahaffey, A. Michael Lincoff, Simona Skerjanec, C. Michael Gibson, Franz Leisch, Derek P. Chew, Charles V. Pollack, Keyur Parikh, Gregg W. Stone, Richard C. Becker, Shaun G. Goodman, Deepak L. Bhatt, Harvey D. White, Maged Amine, Dominick J. Angiolillo, Neal S. Kleiman, William J. French |
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| Rok vydání: | 2009 |
| Předmět: |
Male
Acute coronary syndrome Ticlopidine Myocardial Infarction Administration Oral Hemorrhage chemistry.chemical_compound Cangrelor P2Y12 Double-Blind Method medicine Humans Treatment Failure cardiovascular diseases Acute Coronary Syndrome Angioplasty Balloon Coronary Infusions Intravenous Aged business.industry General Medicine Middle Aged medicine.disease Clopidogrel Combined Modality Therapy Adenosine Monophosphate chemistry Anesthesia Retreatment Conventional PCI Platelet aggregation inhibitor Female business Elinogrel Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | New England Journal of Medicine. 361:2318-2329 |
| ISSN: | 1533-4406 0028-4793 0030-5162 |
| DOI: | 10.1056/nejmoa0908628 |
| Popis: | Cangrelor, a nonthienopyridine adenosine triphosphate analogue, is an intravenous blocker of the adenosine diphosphate receptor P2Y(12). This agent might have a role in the treatment of patients who require rapid, predictable, and profound but reversible platelet inhibition.We performed a large-scale international trial comparing cangrelor with 600 mg of oral clopidogrel administered before percutaneous coronary intervention (PCI) in patients with acute coronary syndromes. The primary efficacy end point was a composite of death from any cause, myocardial infarction, or ischemia-driven revascularization at 48 hours.We enrolled 8877 patients, and 8716 underwent PCI. At 48 hours, cangrelor was not superior to clopidogrel with respect to the primary composite end point, which occurred in 7.5% of patients in the cangrelor group and 7.1% of patients in the clopidogrel group (odds ratio, 1.05; 95% confidence interval [CI], 0.88 to 1.24; P=0.59). Likewise, cangrelor was not superior at 30 days. The rate of major bleeding (according to Acute Catheterization and Urgent Intervention Triage Strategy criteria) was higher with cangrelor, a difference that approached statistical significance (3.6% vs. 2.9%; odds ratio, 1.26; 95% CI, 0.99 to 1.60; P=0.06), but this was not the case with major bleeding (according to the Thrombolysis in Myocardial Infarction criteria) or severe or life-threatening bleeding (according to Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries criteria). A secondary exploratory end point of death from any cause, Q-wave myocardial infarction, or ischemia-driven revascularization showed a trend toward a reduction with cangrelor, but it was not significant (0.6% vs. 0.9%; odds ratio, 0.67; 95% CI, 0.39 to 1.14; P=0.14).Cangrelor, when administered intravenously 30 minutes before PCI and continued for 2 hours after PCI, was not superior to an oral loading dose of 600 mg of clopidogrel, administered 30 minutes before PCI, in reducing the composite end point of death from any cause, myocardial infarction, or ischemia-driven revascularization at 48 hours. (ClinicalTrials.gov number, NCT00305162.) |
| Databáze: | OpenAIRE |
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