Risk of Bleeding Among Cangrelor-Treated Patients Administered Upstream P2Y12 Inhibitor Therapy: The CAMEO Registry

Jennifer Rymer, Brooke Alhanti, Steven Kemp, Deepak L. Bhatt, Ajar Kochar, Dominick J. Angiolillo, Miguel Diaz, Kirk N. Garratt, Neil J. Wimmer, Ron Waksman, Ajay J. Kirtane, Lawrence Ang, Richard Bach, Colin Barker, Ronald Jenkins, Mir B. Basir, Alex Sullivan, Hijrah El-Sabae, Leo Brothers, E. Magnus OhmanW. Schuyler Jones, Jeffrey B. Washam, Tracy Y. Wang

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Little is known about the bleeding risk associated with cangrelor use in patients with myocardial infarction (MI) who are exposed to an oral P2Y12 inhibitor before coronary angiography. Methods: Cangrelor in Acute MI: Effectiveness and Outcomes (CAMEO) is an observational registry studying platelet inhibition for patients with MI. Upstream oral P2Y12 inhibition was defined as receipt of an oral P2Y12 inhibitor within 24 hours before hospitalization or in-hospital before angiography. Among cangrelor-treated patients, we compared bleeding after cangrelor use through 7 days postdischarge between patients with and without upstream oral P2Y12 inhibitor exposure. Results: Among 1802 cangrelor-treated patients with MI, 385 (21.4%) received upstream oral P2Y12 inhibitor treatment. Of these, 101 patients (33.8%) started cangrelor within 1 hour, 103 (34.4%) between 1 and 3 hours, and 95 (31.8%), >3 hours after in-hospital oral P2Y12 inhibitor administration; the remaining received an oral P2Y12 inhibitor before hospitalization. There was no statistically significant difference in rates of bleeding among cangrelor-treated patients with and without upstream oral P2Y12 inhibitor exposure (6.5% vs 8.8%; adjusted odds ratio [OR], 0.62; 95% CI, 0.38-1.01). Bleeding was observed in 5.0%, 10.7%, and 3.2% of patients treated with cangrelor <1, 1 to 3, and >3 hours after the last oral PY12 inhibitor dose, respectively; bleeding rates were not statistically different between groups (1-3 hours vs <1 hour: adjusted OR, 2.70; 95% CI, 0.87-8.32; >3 hours vs <1 hour: adjusted OR, 0.65; 95% CI, 0.15-2.85). Conclusions: Bleeding risk was not observed to be significantly higher after cangrelor treatment in patients with and without upstream oral P2Y12 inhibitor exposure.

Original languageEnglish
Article number101202
JournalJournal of the Society for Cardiovascular Angiography and Interventions
Volume3
Issue number2
DOIs
StatePublished - Feb 2024

Keywords

  • P2Y inhibitor
  • bleeding
  • cangrelor
  • myocardial infarction

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