BRIDGE (Maintenance of PlateletInhibition with Cangrelor afterDiscontinuation of Thienopyridines inPatients Undergoing Surgery)
BRIDGE (Maintenance of Platelet Inhibition withCangrelor after Discontinuation of Thienopyridines inPatients Undergoing Surgery)D Angiolillo (University of Florida College of Medicine, Jacksonville)TCT 2011• Population and treatment: 210 patients with ACS or coronary stents on ticlopidine, clopidogrel, or prasugrel awaiting CABG Randomized to continuous infusions of cangrelor (0.75 µg/kg/min) or placebo for at least 48 hours and within 72 hours of going off the oral antiplatelets; the infusion was withdrawn one to six hours before CABG Platelet function monitored by the VerifyNow P2Y12 assay• Primary outcomes: Efficacy: Rate of achieving platelet reactivity units (PRU) <240 during the infusion Safety: Excessive CABG-related bleeding during the procedure or subsequent hospitalization
BRIDGE: Results (efficacy)• Significantly more patients on cangrelor than placebo had low levels of platelet reactivity throughout the entire infusion• The rate of the primary end point during the infusion was 98.8% for cangrelor and 19.0% among controls (p<0.0001)Platelet reactivity at baseline and during and after randomized infusion,in PRU on the VerifyNow system End point: Mean PRU Cangrelor, n=93 Placebo, n=90 p Baseline 210.9 214.1 0.817 During infusion 68.9 263.7 <0.001 After end of infusion 279.7 297.8 0.212
BRIDGE: Results (safety)• The primary safety end point didnt differ significantly between the two groups (p=0.763)• There was a numerical increase in minor bleeding complications (about 18% vs 10%) among cangrelor recipientsExcessive CABG-related bleeding (during the procedure or after untildischarge) End point* Cangrelor, n=106 (%) Placebo, n=101 (%) OR (95% CI) Total CABG-related bleeding 11.8 10.4 1.15 (0.47–2.79) Surgical reexploration 2.0 2.1 0.94 (0.13–6.81) 24-hour chest-tube output >1.5L 7.8 5.2 1.55 (0.49–4.91) Incidence of packed RBCs >4 U 5.9 8.3 0.69 (0.23–2.06)*Defined as occurrence of one or more of the following events during CABG or the postoperativehospitalization: Surgical reexploration, 24-hour chest-tube output >1.5 L, packed RBC transfusion>4 units)
BRIDGE: Commentary*"This is the first time we have a trial assessing, in a prospective, randomized,double-blind fashion, the use of a novel [antiplatelet] agent that has the idealproperties for bridging. And the trial clearly shows that we are able to achieve andsustain adequate levels of P2Y12 inhibition during the preoperative stage, withoverall favorable safety signals." - Dr Dominick Angiolillo*All comments from BRIDGE to surgery: Cangrelor may safely wean ACS patients off oral antiplatelets(http://www.theheart.org/article/1306197.do)
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