(166) Comparison of Cangrelor vs Eptifibatide as a Bridge to Cardiac Surgery in a Large Academic Hospital

Introduction: Cangrelor and eptifibatide are agents commonly used as a bridge to cardiac surgery in patients who are taking maintenance oral P2Y12 inhibitors for prior cardiac stenting. However, neither agent currently has a FDA labeled indication for this use. There are no current guidelines to suggest how to choose one agent over the other, so this study aimed to assess the safety of both agents along with the direct and indirect costs of each when used as a bridge to cardiac surgery. Although cangrelor is associated with a higher average wholesale price, we hypothesize that eptifibatide may be associated with a higher number of bleed events leading to an increased requirement for blood products and therefore an overall increase in cost of treatment.

Methods: A retrospective, single-center, chart review was performed. Patients who had received either cangrelor or eptifibatide as a bridge to cardiac surgery during the study time period of June 1, 2016 to June 1, 2023 were included. The primary objective of this study was to determine the safety of cangrelor and eptifibatide when used as a bridge to cardiac surgery. Safety assessment was based on the CABG surgery-related hemorrhage criteria from the BRIDGE study. The secondary objectives of this study included assessing the drug cost as well as comparing use of blood products for bleeding events.

Results: A total of 816 patients were screened and 23 patients were included: six patients in the cangrelor group and 17 patients in the eptifibatide group. No statistically significant differences were determined in regard to safety, except for the utilization of platelets (5 patients in the cangrelor group vs. 4 patients in the eptifibatide group, P=0.010).

Conclusions: Safety was similar between the cangrelor group and eptifibatide group based on the CABG surgery-related hemorrhage criteria from the BRIDGE study. However, there was a higher drug cost associated with the cangrelor group, along with higher use of platelets and DDAVP. Due to small sample size and retrospective nature of the study, further studies are recommended to assess safety and cost associated with cangrelor vs. eptifibatide as a bridge to cardiac surgery in order to help aid in the development of protocols to standardize use.