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Nov 12

Cangrelor a Good Bridge for CABG

The novel fast-acting IV antiplatelet drug cangrelor provided an effective bridge for patients on thienopyridine therapy, including clopidogrel, who required bypass surgery, according to results of the late-breaking BRIDGE trial by Dominick J. Agiolillo, MD, PhD, from the University of Florida College of Medicine in Jacksonville.

Guidelines recommend discontinuing thienopyridines five to seven days prior to surgery to minimize bleeding. In urgency one will often proceed without weaning the patient from Clopidogrel. If it’s elective and the stent hasn’t been placed within the last year, surgery will be postponed for five days.

If the patient falls somewhere between those two extremes, one may go for to measure the platelet function. Often, the patient won’t have any platelet inhibition, but if it’s inhibited by 70% or more, one will postpone the procedure.

Cangrelor is an IV ADP–P2Y12 receptor antagonist with a quick onset and quick offset. It has a plasma half-life of three to six minutes and patients will return to normal platelet function in 60 minutes.

Thienopyridine are irreversible agents. The BRIDGE trial was a stage II randomized, double-blind placebo controlled study. Stage I had determined a cangrelor dose of 0.75 µg/kg/minute was optimal. After clopidogrel was stopped, patients were administered cangrelor or a placebo for at least 48 hours, which was then discontinued one to six hours before surgery. (MedPage Today)

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