NDLI: Platelet inhibition with cangrelor in patients undergoing PCI.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Gibson, C. Michael White, Harvey D. Kleiman, Neal S. Becker, Richard C. Lincoff, A. Michael Stone, Gregg W. Mcnulty, Steven Leisch, Franz Angiolillo, Dominick J. Skerjanec, Simona Goodman, Shaun G. Chew, Derek P. Harrington, Robert A. French, William J. Pollack, Charles V. Montalescot, Gilles Mahaffey, Kenneth W. Amine, Maged Parikh, Keyur H. Bhatt, Deepak L.
Description	Author Affiliation: Harrington RA ( Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA. robert.harrington@duke.edu)
Abstract	BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.)
ISSN	00284793
Issue Number	24
Volume Number	361
e-ISSN	15334406
Journal	New England Journal of Medicine
Language	English
Publisher	Massachusetts Medical Society (United States)
Publisher Date	2009-12-10
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Acute Coronary Syndrome Therapy Adenosine Monophosphate Analogs & Derivatives Angioplasty, Balloon, Coronary Platelet Aggregation Inhibitors Therapeutic Use Drug Therapy Mortality Adverse Effects Administration, Oral Aged Combined Modality Therapy Double-Blind Method Female Hemorrhage Chemically Induced Humans Infusions, Intravenous Male Middle Aged Myocardial Infarction Prevention & Control Retreatment Ticlopidine Treatment Failure Comparative Study Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't Medicine
Content Type	Text
Resource Type	Article
Subject	Medicine

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