Abstract Number: PB0429
Meeting: ISTH 2021 Congress
Background: Cangrelor, a P2HY12 inhibitor, with a half-life is about 3 to 5 minutes, a clearance of 50L/h and an off set about 1 hour. Dose infusion protocol is the same, ie: 30µg/kg bolus, followed by 4µg/kg/min during 2 to 4 hours maximum with a bridge with another P2Y12.
Aims: However, long-term prescription of Cangrelor is not describe in the literature. Four experiences situations with cangrelor long-term prescription following flow-diverter or stent-assisted coiling procedure in neurosurgical environment are described.
Methods: As the cangrelor use is off label in intracranial stenting, all the indications were discussed collegially through a multidisciplinary discussion (neurosurgeon, neuro-intensivist, neuro-radiologist).
Results: Case 1: Cangrelor-ticagrelor switch was organised with Ticagrelor administered to the patient 30min before the stop of Cangrelor. Six hours after a cangrelor-ticagrelor switch, the arteriography made for a brutally coma showed an extension of the thrombosis of the branches covered by the flow diverter with vasospasm of the left M1 treated by a chemical dilatation.
Case 2: Multiples therapeutic windows for external ventricular drain changeset and removal with non-complications.
Case 3: No therapeutic windows, but a shock colic was developed, with vasospasm of the splanchnic arterial network at day 22.
Case 4: Multiples therapeutic windows, cangrelor IV line was unplugged during 3 hours with no clinical consequences for the patient
Conclusions: Cangrelor long term administration is part of the solution of stent or coil implantation in neurosurgical patients. Its use needs an ICU environment with frequent clinical exam. The infusion process has to be done by trained paramedical staff. The therapeutics windows or Ticagrelor-bridge periods have to be under high surveillance. With all these restrictions, cangrelor could be part of future therapeutic arsenal with complicated cases mixing neurosurgery and interventional neuroradiology.
To cite this abstract in AMA style:Duranteau O, Abdennour L, Drir M, Clarencon F, Degos V. Cangrelor Long Term Prescription, Several Scenarios: A Case Report Series [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/cangrelor-long-term-prescription-several-scenarios-a-case-report-series/. Accessed May 16, 2022.
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