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Erschienen in: American Journal of Cardiovascular Drugs 1/2024

23.11.2023 | Systematic Review

Safety and Efficacy of Cangrelor in Acute Coronary Syndromes: A Systematic Review and Network Meta-Analysis

verfasst von: Mostafa Reda Mostafa, Mohamed Magdi Eid, Ahmed K. Awad, Andrew Takla, Abdul Rhman Hassan, Basant E. Katamesh, Majd M. AlBarakat, Abdul Rhman Ziada, Sarah Mohamed, Karim M. Al-Azizi, Andrew M. Goldsweig

Erschienen in: American Journal of Cardiovascular Drugs | Ausgabe 1/2024

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Abstract

Introduction

Cangrelor is a potent intravenous non-thienopyridine P2Y12 inhibitor. We conducted a network meta-analysis to study the efficacy and safety of cangrelor as compared with the oral P2Y12 inhibition, clopidogrel, or placebo in acute coronary syndromes.

Methods

This meta-analysis followed the Cochrane collaboration guidelines and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols. Outcomes of interest included all-cause mortality, myocardial infarction, stent thrombosis, target vessel revascularization, major bleeding, minor bleeding, and the need for blood transfusion.

Results

The analysis was comprised of 6 studies including 26,444 patients treated with cangrelor, clopidogrel, or placebo. There were no statistically significant differences in the incidence of all-cause mortality, myocardial infarction, stent thrombosis, target vessel revascularization, or major bleeding. Cangrelor was associated with a higher risk of minor bleeding than clopidogrel or placebo, with no difference in requiring blood transfusion.

Conclusion

Cangrelor has comparable outcomes to clopidogrel in patients with acute coronary syndromes and can be used as a reliable alternative in this population.
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Literatur
1.
Zurück zum Zitat Mehta SR, Cannon CP, Fox KA, Wallentin L, Boden WE, Spacek R, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005;293(23):2908–17.CrossRefPubMed Mehta SR, Cannon CP, Fox KA, Wallentin L, Boden WE, Spacek R, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005;293(23):2908–17.CrossRefPubMed
2.
Zurück zum Zitat Bhatt DL. To cath or not to cath: that is no longer the question. JAMA. 2005;293(23):2935–7.CrossRefPubMed Bhatt DL. To cath or not to cath: that is no longer the question. JAMA. 2005;293(23):2935–7.CrossRefPubMed
3.
Zurück zum Zitat Armstrong EJ, Feldman DN, Wang TY, Kaltenbach LA, Yeo K-K, Wong SC, et al. Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. JACC Cardiovasc Interv. 2012;5(2):131–40.CrossRefPubMed Armstrong EJ, Feldman DN, Wang TY, Kaltenbach LA, Yeo K-K, Wong SC, et al. Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. JACC Cardiovasc Interv. 2012;5(2):131–40.CrossRefPubMed
4.
Zurück zum Zitat Yousuf O, Bhatt DL. The evolution of antiplatelet therapy in cardiovascular disease. Nat Rev Cardiol. 2011;8(10):547–59.CrossRefPubMed Yousuf O, Bhatt DL. The evolution of antiplatelet therapy in cardiovascular disease. Nat Rev Cardiol. 2011;8(10):547–59.CrossRefPubMed
5.
Zurück zum Zitat Agrawal K, Bhatt DL. Antiplatelet therapy: does prasugrel or ticagrelor suffice in patients with STEMI? Nat Rev Cardiol. 2013;10(3):121–2.CrossRefPubMed Agrawal K, Bhatt DL. Antiplatelet therapy: does prasugrel or ticagrelor suffice in patients with STEMI? Nat Rev Cardiol. 2013;10(3):121–2.CrossRefPubMed
6.
Zurück zum Zitat Heestermans AA, van Werkum JW, Taubert D, Seesing TH, von Beckerath N, Hackeng CM, et al. Impaired bioavailability of clopidogrel in patients with a ST-segment elevation myocardial infarction. Thromb Res. 2008;122(6):776–81.CrossRefPubMed Heestermans AA, van Werkum JW, Taubert D, Seesing TH, von Beckerath N, Hackeng CM, et al. Impaired bioavailability of clopidogrel in patients with a ST-segment elevation myocardial infarction. Thromb Res. 2008;122(6):776–81.CrossRefPubMed
7.
Zurück zum Zitat Angiolillo DJ, Schneider DJ, Bhatt DL, French WJ, Price MJ, Saucedo JF, et al. Pharmacodynamic effects of cangrelor and clopidogrel: the platelet function substudy from the cangrelor versus standard therapy to achieve optimal management of platelet inhibition (CHAMPION) trials. J Thromb Thrombolysis. 2012;34(1):44–55.CrossRefPubMed Angiolillo DJ, Schneider DJ, Bhatt DL, French WJ, Price MJ, Saucedo JF, et al. Pharmacodynamic effects of cangrelor and clopidogrel: the platelet function substudy from the cangrelor versus standard therapy to achieve optimal management of platelet inhibition (CHAMPION) trials. J Thromb Thrombolysis. 2012;34(1):44–55.CrossRefPubMed
8.
Zurück zum Zitat Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339: b2535.CrossRefPubMedPubMedCentral Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339: b2535.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366: l4898.CrossRefPubMed Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366: l4898.CrossRefPubMed
10.
Zurück zum Zitat Abtan J, Steg PG, Stone GW, Mahaffey KW, Gibson CM, Hamm CW, et al. Efficacy and safety of cangrelor in preventing periprocedural complications in patients with stable angina and acute coronary syndromes undergoing percutaneous coronary intervention: the CHAMPION PHOENIX Trial. JACC Cardiovasc Interv. 2016;9(18):1905–13.CrossRefPubMed Abtan J, Steg PG, Stone GW, Mahaffey KW, Gibson CM, Hamm CW, et al. Efficacy and safety of cangrelor in preventing periprocedural complications in patients with stable angina and acute coronary syndromes undergoing percutaneous coronary intervention: the CHAMPION PHOENIX Trial. JACC Cardiovasc Interv. 2016;9(18):1905–13.CrossRefPubMed
11.
Zurück zum Zitat Angiolillo DJ, Firstenberg MS, Price MJ, Tummala PE, Hutyra M, Welsby IJ, et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial. JAMA. 2012;307(3):265–74.CrossRefPubMedPubMedCentral Angiolillo DJ, Firstenberg MS, Price MJ, Tummala PE, Hutyra M, Welsby IJ, et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial. JAMA. 2012;307(3):265–74.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Grimfjärd P, Lagerqvist B, Erlinge D, Varenhorst C, James S. Clinical use of cangrelor: nationwide experience from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Eur Heart J Cardiovasc Pharmacother. 2019;5(3):151–7.CrossRefPubMed Grimfjärd P, Lagerqvist B, Erlinge D, Varenhorst C, James S. Clinical use of cangrelor: nationwide experience from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Eur Heart J Cardiovasc Pharmacother. 2019;5(3):151–7.CrossRefPubMed
13.
Zurück zum Zitat Bhatt DL, Lincoff AM, Gibson CM, Stone GW, McNulty S, Montalescot G, et al. Intravenous platelet blockade with cangrelor during PCI. N Engl J Med. 2009;361(24):2330–41.CrossRefPubMed Bhatt DL, Lincoff AM, Gibson CM, Stone GW, McNulty S, Montalescot G, et al. Intravenous platelet blockade with cangrelor during PCI. N Engl J Med. 2009;361(24):2330–41.CrossRefPubMed
14.
Zurück zum Zitat Bhatt DL, Stone GW, Mahaffey KW, Gibson CM, Steg PG, Hamm CW, et al. Effect of platelet inhibition with cangrelor during PCI on ischemic events. N Engl J Med. 2013;368(14):1303–13.CrossRefPubMed Bhatt DL, Stone GW, Mahaffey KW, Gibson CM, Steg PG, Hamm CW, et al. Effect of platelet inhibition with cangrelor during PCI on ischemic events. N Engl J Med. 2013;368(14):1303–13.CrossRefPubMed
15.
Zurück zum Zitat Firstenberg MS, Dyke CM, Angiolillo DJ, Ramaiahm C, Price M, Brtko M, et al. Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery. Heart Surg Forum. 2013;16(2):E60–9.CrossRefPubMed Firstenberg MS, Dyke CM, Angiolillo DJ, Ramaiahm C, Price M, Brtko M, et al. Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery. Heart Surg Forum. 2013;16(2):E60–9.CrossRefPubMed
16.
Zurück zum Zitat Harrington RA, Stone GW, McNulty S, White HD, Lincoff AM, Gibson CM, et al. Platelet inhibition with cangrelor in patients undergoing PCI. N Engl J Med. 2009;361(24):2318–29.CrossRefPubMed Harrington RA, Stone GW, McNulty S, White HD, Lincoff AM, Gibson CM, et al. Platelet inhibition with cangrelor in patients undergoing PCI. N Engl J Med. 2009;361(24):2318–29.CrossRefPubMed
17.
Zurück zum Zitat Steg PG, Bhatt DL, Hamm CW, Stone GW, Gibson CM, Mahaffey KW, et al. Effect of cangrelor on periprocedural outcomes in percutaneous coronary interventions: a pooled analysis of patient-level data. Lancet. 2013;382(9909):1981–92.CrossRefPubMed Steg PG, Bhatt DL, Hamm CW, Stone GW, Gibson CM, Mahaffey KW, et al. Effect of cangrelor on periprocedural outcomes in percutaneous coronary interventions: a pooled analysis of patient-level data. Lancet. 2013;382(9909):1981–92.CrossRefPubMed
18.
Zurück zum Zitat De Luca L, Steg PG, Bhatt DL, Capodanno D, Angiolillo DJ. Cangrelor: clinical data, contemporary use, and future perspectives. J Am Heart Assoc. 2021;10(13): e022125.CrossRefPubMedPubMedCentral De Luca L, Steg PG, Bhatt DL, Capodanno D, Angiolillo DJ. Cangrelor: clinical data, contemporary use, and future perspectives. J Am Heart Assoc. 2021;10(13): e022125.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569–619.CrossRefPubMed Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569–619.CrossRefPubMed
20.
Zurück zum Zitat Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the Management of Acute Coronary Syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(23):2999–3054.CrossRefPubMed Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the Management of Acute Coronary Syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(23):2999–3054.CrossRefPubMed
21.
Zurück zum Zitat Montalescot G, Bolognese L, Dudek D, Goldstein P, Hamm C, Tanguay JF, et al. Pretreatment with prasugrel in non-ST-segment elevation acute coronary syndromes. N Engl J Med. 2013;369(11):999–1010.CrossRefPubMed Montalescot G, Bolognese L, Dudek D, Goldstein P, Hamm C, Tanguay JF, et al. Pretreatment with prasugrel in non-ST-segment elevation acute coronary syndromes. N Engl J Med. 2013;369(11):999–1010.CrossRefPubMed
22.
Zurück zum Zitat Collet JP, Silvain J, Bellemain-Appaix A, Montalescot G. Pretreatment with P2Y12 inhibitors in non-ST-Segment-elevation acute coronary syndrome: an outdated and harmful strategy. Circulation. 2014;130(21):1904–14 (discussion 14).CrossRefPubMed Collet JP, Silvain J, Bellemain-Appaix A, Montalescot G. Pretreatment with P2Y12 inhibitors in non-ST-Segment-elevation acute coronary syndrome: an outdated and harmful strategy. Circulation. 2014;130(21):1904–14 (discussion 14).CrossRefPubMed
23.
Zurück zum Zitat Alexopoulos D, Bhatt DL, Hamm CW, Steg PG, Stone GW. Early P2Y12 inhibition in ST-segment elevation myocardial infarction: bridging the gap. Am Heart J. 2015;170(1):3–12.CrossRefPubMed Alexopoulos D, Bhatt DL, Hamm CW, Steg PG, Stone GW. Early P2Y12 inhibition in ST-segment elevation myocardial infarction: bridging the gap. Am Heart J. 2015;170(1):3–12.CrossRefPubMed
24.
Zurück zum Zitat Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045–57.CrossRefPubMed Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045–57.CrossRefPubMed
25.
Zurück zum Zitat Bhatt DL, Topol EJ. Current role of platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes. JAMA. 2000;284(12):1549–58.CrossRefPubMed Bhatt DL, Topol EJ. Current role of platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes. JAMA. 2000;284(12):1549–58.CrossRefPubMed
26.
Zurück zum Zitat Vaduganathan M, Harrington RA, Stone GW, Deliargyris EN, Steg PG, Gibson CM, et al. Cangrelor with and without glycoprotein IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2017;69(2):176–85.CrossRefPubMed Vaduganathan M, Harrington RA, Stone GW, Deliargyris EN, Steg PG, Gibson CM, et al. Cangrelor with and without glycoprotein IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2017;69(2):176–85.CrossRefPubMed
27.
Zurück zum Zitat Bellemain-Appaix A, O’Connor SA, Silvain J, Cucherat M, Beygui F, Barthélémy O, et al. Association of clopidogrel pretreatment with mortality, cardiovascular events, and major bleeding among patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. JAMA. 2012;308(23):2507–16.CrossRefPubMed Bellemain-Appaix A, O’Connor SA, Silvain J, Cucherat M, Beygui F, Barthélémy O, et al. Association of clopidogrel pretreatment with mortality, cardiovascular events, and major bleeding among patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. JAMA. 2012;308(23):2507–16.CrossRefPubMed
Metadaten
Titel
Safety and Efficacy of Cangrelor in Acute Coronary Syndromes: A Systematic Review and Network Meta-Analysis
verfasst von
Mostafa Reda Mostafa
Mohamed Magdi Eid
Ahmed K. Awad
Andrew Takla
Abdul Rhman Hassan
Basant E. Katamesh
Majd M. AlBarakat
Abdul Rhman Ziada
Sarah Mohamed
Karim M. Al-Azizi
Andrew M. Goldsweig
Publikationsdatum
23.11.2023
Verlag
Springer International Publishing
Erschienen in
American Journal of Cardiovascular Drugs / Ausgabe 1/2024
Print ISSN: 1175-3277
Elektronische ISSN: 1179-187X
DOI
https://doi.org/10.1007/s40256-023-00616-2

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