Cangrelor: Additional Research Findings Not Translating into Clinical Practice

The potent and fast endovenous platelet inhibition provided by Cangrelor reduces ischemic events early in the course of acute coronary syndrome. However, and despite mounting evidence, the drug is not reaching the clinical practice.  

This is a sub-analysis of the CHAMPION PHOENIX, which sought the timing, number and type of early events that could be prevented within 2 hours of randomization by using cangrelor (as sole P2Y12 endovenous inhibitor) vs clopidogrel.

Most ischemic events observed in the study (63%) occurred within 2 hours after randomization, being repeat MI the most common, followed by stent thrombosis, ischemia driven revascularization, and death. 

Cangrelor significantly reduced the combined primary end point vs clopidogrel (4.1% vs 5.4%; HR, 0.76 CI 95%, 0.64 to 0.90; p=0.002). Additionally, it cut down the chance of acute stent thrombosis by nearly half within 2 hours of cangrelor administration (0.9% versus 1.6%; HR 0.57 CI 95%, 0.40 to 0.80; p=0.001).

All these advantages of the potent and faster cangrelor (thanks to its endovenous delivery) disappear if analyzed between 2 and 48 hours after randomization. 

Read also: Clnical Practice Dissociated from Study Outcomes: Bad News for Our Patients?

The benefits of the only endovenous P2Y12 inhibitor can only be found within the two first hours. This might be the reason why it has not been adopted in the cath lab, despite favorable data. 

Moderate or severe bleeding events were rare and saw no differences between branches. 

Conclusion

The reduction of ischemic events and general efficacy of cangrelor happen fairly early and during the time when patients are being actively treated with the drug. Event curves level off 2 hours after randomization vs. clopidogrel. 

Original title: Ischemic Events Occur Early in Patients Undergoing Percutaneous Coronary Intervention and Are Reduced With Cangrelor: Findings From CHAMPION PHOENIX.

Reference: Matthew A. Cavender et al. Circ Cardiovasc Interv. 2022 Jan;15(1):e010390. doi: 10.1161/CIRCINTERVENTIONS.120.010390.

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