Acute myocardial infarction complicating ischemic stroke: is there room for cangrelor?

Abstract Acute myocardial infarction (AMI) complicating ischemic stroke is a well known and undertreated event. A conservative management is not infrequent in these settings, due to the fear of hemorrhagic complications related to antithrombotic therapy. Notably, an invasive approach with a primary percutaneous coronary intervention (PCI) has been shown to be associated with a lower in-hospital mortality in patients with concomitant ischemic stroke and AMI. The optimal antiplatelet regimen in these cases has been not clearly defined, yet. We report two cases of patients with AMI complicating ischemic stroke, successfully treated with cangrelor infusion, which was started during PCI and maintained up to 48 h at bridge therapy dosage (0.75 mcg/kg/min). Both patients underwent successful PCI in the acute phase, and neither ischemic nor hemorrhagic complications occurred during in-hospital stay.

[1]  G. Tiscia,et al.  Management of cerebral and splanchnic vein thrombosis associated with thrombocytopenia in subjects previously vaccinated with Vaxzevria (AstraZeneca): a position statement from the Italian Society for the Study of Haemostasis and Thrombosis (SISET). , 2021, Blood transfusion = Trasfusione del sangue.

[2]  P. Gurbel,et al.  “Blueprinting” thrombogenicity and antithrombotic drug response at the bedside in patients presenting emergently with symptoms of acute stroke , 2019, Journal of Thrombosis and Thrombolysis.

[3]  Deepak L. Bhatt,et al.  Practical considerations for cangrelor use in patients with acute coronary syndromes , 2019, European heart journal. Acute cardiovascular care.

[4]  R. Hanel,et al.  Safety and efficacy of cangrelor in acute stenting for the treatment of cerebrovascular pathology: preliminary experience in a single-center pilot study , 2018, Journal of NeuroInterventional Surgery.

[5]  F. Maes,et al.  Transcarotid Compared With Other Alternative Access Routes for Transcatheter Aortic Valve Replacement , 2018, Circulation. Cardiovascular interventions.

[6]  Deepak L. Bhatt,et al.  Incidence, Predictors, and Outcomes of Acquired Thrombocytopenia After Percutaneous Coronary Intervention: A Pooled, Patient-Level Analysis of the CHAMPION Trials (Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition) , 2018, Circulation. Cardiovascular interventions.

[7]  Francesca N. Delling,et al.  Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association , 2018, Circulation.

[8]  W. Ageno,et al.  A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery: Surgery After Stenting 2. , 2018, JACC. Cardiovascular interventions.

[9]  M. Alkhouli,et al.  Incidence and Outcomes of Myocardial Infarction in Patients Admitted With Acute Ischemic Stroke , 2017, Stroke.

[10]  P. Gurbel,et al.  First report of the point-of-care TEG: A technical validation study of the TEG-6S system , 2016, Platelets.

[11]  F. Cozzolino,et al.  Glycoprotein IIb-IIIa inhibitors for acute ischaemic stroke. , 2014, The Cochrane database of systematic reviews.

[12]  Gregg W Stone,et al.  Effect of platelet inhibition with cangrelor during PCI on ischemic events. , 2013, The New England journal of medicine.

[13]  M. Wintermark,et al.  Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association , 2013, Stroke.

[14]  M. Price,et al.  Bridging Antiplatelet Therapy With Cangrelor in Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial , 2012 .

[15]  Deepak L. Bhatt,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 , 2012, Journal of Thrombosis and Thrombolysis.

[16]  M. Price,et al.  Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial. , 2012, JAMA.

[17]  Gregg W Stone,et al.  Platelet inhibition with cangrelor in patients undergoing PCI. , 2009, The New England journal of medicine.

[18]  Deepak L. Bhatt,et al.  Intravenous platelet blockade with cangrelor during PCI. , 2009, The New England journal of medicine.