(944) Evaluation of the Safety of Cangrelor Use Among Patients Receiving Mechanical Circulatory Support

Introduction: Cangrelor, the only intravenous P2Y12 receptor antagonist, has a rapid time to onset and short half-life. Therefore, it can be an attractive therapeutic option for critically ill patients. Data describing the safety of cangrelor use among patients also receiving a variety of mechanical circulatory support (MCS) modalities is limited. This study aims to describe cangrelor use in MCS and examine the incidence of bleeding and thrombotic events.

Methods: This was a retrospective, single-center cohort study conducted at a tertiary academic medical center. Patients were included if they received cangrelor for at least 12 hours while on MCS from January 2022 to July 2024. Patients were followed from time of cangrelor initiation to 30 days after discontinuation. The primary outcome was incidence of bleeding or thrombotic events. Secondary endpoints included quantity of blood products transfused, coadministration of anticoagulants, and 30-day mortality. Descriptive statistics were utilized.

Results: Of the total 12 patients included in this analysis, the median (IQR) age was 57 (49-65) years and all included were male. A variety of MCS strategies were utilized: 5 (41.7%) intra-aortic balloon pump, 9 (75%) Impella®, and 4 (33.3%) VA-ECMO. The majority of patients were treated with concomitant heparin (91.7%). The median duration of MCS was 9 (4-20) days and cangrelor was 5 (2-10) days. Bleeding events occurred in 6 (50%) patients. Of these, 4 (66.7%) events were classified as a major bleed using the Interagency Registry for Mechanically Assisted Circulatory Support criteria. Four (66.7%) patients required transfusion with packed red blood cells (PRBC), and a median of 6 (2-15) units of PRBCs were administered. Thrombotic events occurred in 2 (16.7%) patients; neither of which included stent thrombosis. Mortality occurred in 2 (16.7%) patients within 30 days of cangrelor discontinuation.

Conclusions: Our results suggest a high rate of bleeding events among patients on MCS that received cangrelor; a consistent finding among prior reports. Multicenter cohorts with comparisons to enteral antiplatelet therapies should be conducted to further evaluate this practice and to accurately describe potential risks and benefits of this intervention.