Efficacy and Safety of Very-Low-Dose Cangrelor Following Acute Neuroendovascular Intervention

Introduction: Cangrelor has favorable pharmacokinetic properties that make it ideal during neuroendovascular procedures. It exhibits a rapid onset and offset of antiplatelet activity. Due to the balance of bleeding and thrombotic risks, determining an optimal antiplatelet regimen is critical. The purpose of this study was to report the safety and efficacy of periprocedural very low dose cangrelor and assess platelet function testing to optimize antiplatelet therapy.


Methods: This retrospective study examined very low dose cangrelor use during neuroendovascular procedures for acute ischemic stroke. Cangrelor was administered as a 7.5-15 mcg/kg IV loading dose, followed by an IV infusion of 0.25-0.5 mcg/kg/minute to patients undergoing stenting or who required treatment of an intraluminal thrombus. Outcomes included safety events (bleeding and thrombotic complications), length of intensive care unit (ICU) and hospital stay, and an examination of platelet function testing.


Results: Fifty-six patients received very low dose cangrelor during stenting and/or for intraluminal thrombus treatment. Eleven patients (19.6%) experienced an adverse bleeding event related to cangrelor administration. Eight events were asymptomatic and did not alter antiplatelet management. Two patients experienced thrombotic events during cangrelor infusion. The average ICU and hospital length of stay was 5.2 days and 10.5 days, respectively. Forty-two patients underwent platelet function testing while on cangrelor monotherapy, for which 69% were therapeutic.


Conclusions: Very low dose cangrelor may be effective in preventing thrombotic complications with a low rate of symptomatic bleeding events in patients undergoing neuroendovascular procedures. The incorporation of platelet function testing may optimize antiplatelet selection and dosing after a neuroendovascular procedure.