Parenteral Antiplatelet Use in the Neurocritical Care Patient Population and Associated Outcomes

Introduction: Cangrelor and tirofiban are agents used in percutaneous coronary interventions (PCI) to reduce the risk of periprocedural thromboembolic complications. To this point, there have only been retrospective reviews and case reports investigating their use in neuroendovascular procedures or bridging in the neurocritical care population. Management of antiplatelet therapy during bridging or neuroendovascular procedures is not standardized. The aim of our study was to evaluate the prescribing patterns for both indications while assessing the efficacy and safety of their use at a large academic medical center.


Methods: This was a single-center, retrospective cohort study of adult patients who received cangrelor or tirofiban for a neuroendovascular indication and were admitted to the Neurological Intensive Care Unit (NICU) at Cleveland Clinic Main Campus between May 1, 2020, and April 30, 2024. The primary objective of this study was to describe the incidence of bleeding events in neuroendovascular patients receiving either cangrelor or tirofiban in the NICU. Secondary objectives include describing the timing of transitioning to and from oral antiplatelet agents, and efficacy outcomes in patients who received cangrelor and tirofiban in the NICU.


Results: A total of 31 patients completed 44 courses of therapy. There were 18 patients in the cangrelor cohort and 26 in the tirofiban cohort. There were 8 bleeding complications in the cangrelor cohort, with 4 of those being major and 4 being minor as defined by the ISTH bleeding criteria. The tirofiban cohort had 1 bleeding complication, defined as major by the ISTH bleeding criteria. Both groups had 1 new or recurrent stoke.


Conclusions: There were eight bleeding events in the cangrelor cohort and one bleeding event in the tirofiban cohort with one instance of a new or recurrent stroke seen in each. These agents were used for appropriate indications with doses seen in previous literature. Our safety and efficacy data for the use of cangrelor and tirofiban in the neurocritical care population seems consistent with previous literature; however, larger prospective studies with well-balanced cohorts are needed to draw conclusions on whether either parenteral antiplatelet agent has better safety and efficacy profiles compared to the other.