Christine Ji, PharmD, , BCPS, BCCP
Clinical Pharmacy Specialist Cardiology
Massachusetts General Hospital
Boston, Massachusetts
Disclosure information not submitted.
Allison Yun, PharmD
PGY-1 Pharmacy Resident
Massachusetts General Hospital, United States
Disclosure information not submitted.
Alex Toyoda, PharmD, BCCP
Clinical Pharmacist Cardiology
Massachusetts General Hospital, United States
Disclosure information not submitted.
Edmond Solomon, PharmD, BCCP, BCPS
Clinical Pharmacist Cardiology
Massachusetts General Hospital, United States
Disclosure information not submitted.
Russel Roberts, BCCCP, PharmD
Clinical Manager (Cardiology, Critical Care and Transplant Services)
Massachusetts General Hospital
Boston, Massachusetts, United States
Disclosure information not submitted.
Title: Safety and efficacy of periprocedural bridging with cangrelor versus eptifibatide
Introduction: Patients with percutaneous coronary interventions (PCI) undergoing procedures often require interruptions in their dual antiplatelet therapy (DAPT). Periprocedural bridging is considered for patients at high thrombotic risk using intravenous (IV) cangrelor, a reversible P2Y12 inhibitor with a short half-life, and eptifibatide, a glycoprotein IIb/IIIa inhibitor, with a slightly longer half-life but less costly alternative. This study aims to assess the safety and efficacy of cangrelor compared to eptifibatide when used in a periprocedural setting.
Methods: This retrospective cohort study reviewed patients hospitalized on cangrelor or eptifibatide as a bridge to any procedure. A total of 75 patients were included in the study analysis who were bridged to procedures (cangrelor, n=50; eptifibatide, n=25). The primary outcome was the bleeding events defined by Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) criteria. The secondary outcomes included the composite inpatient major cardiac adverse events (MACE), duration of ICU stay, and cost savings of using eptifibatide as an alternative.
Results: There was no statistically significant differences in overall bleeding events defined by GUSTO; mild bleeding (8% vs. 8%), moderate bleeding (28% vs. 48%), and severe bleeding (8% vs. 8%) between cangrelor and eptifibatide, respectively (p=0.35). The moderate bleeding in eptifibatide group was driven by the intra-operative transfusion requirements, where we observed higher number of cardiac surgery compared to non-cardiac surgery that required more transfusions at baseline, irrespective of the bridging agent. The MACE outcomes were also similar between cangrelor and eptifibatide (10% vs. 8%, p=0.78) without significant differences in the duration of ICU stay in days (9 +/- 14 vs. 11 +/- 12, p=0.69). The average cost savings per each cangrelor patient without clear contraindications to eptifibatide was calculated out to be $5,824 per patient f they were to be on the equivalent duration of eptifibatide.
Conclusion: Cangrelor and eptifibatide were similar in terms of safety and efficacy when used as periprocedural bridging agents in patients with recent coronary stents. Further studies are needed to determine its applicability specifically in patients at high thrombotic and hemorrhagic risk.