Department of Pharmacy, Albany Medical Center, Albany, New York, USA.
Department of Neurosurgery, Albany Medical Center, Albany, New York, USA.
Pharmacotherapy. 2021 Oct;41(10):811-819. doi: 10.1002/phar.2619. Epub 2021 Sep 18.
The optimal antiplatelet therapy for emergent neuroendovascular stenting is uncertain. Cangrelor is an intravenous P2Y12 inhibitor that is an attractive option due its favorable pharmacokinetic profile and ease of measurability but optimal dosing remains unclear. The primary objective of this study is to characterize the dose response of low dose cangrelor (<2 mcg/kg/min) with the utilization of platelet function testing (PFT).
A retrospective review of all patients treated with cangrelor for either procedural stenting or bridging was conducted between January 1st, 2019 and October 31st, 2020. Seventy-two patients met inclusion criteria. An in-depth analysis of dose response to low dose cangrelor based on PFT was performed.
Neuroendovascular patients treated with cangrelor.
Albany Medical Center Hospital.
Patients who underwent procedural stenting were given a bolus of 5 mcg/kg and an initial infusion rate of either 0.75 mcg/kg/min or 1 mcg/kg/min. Patients who were bridged with cangrelor were administered an initial infusion rate of 0.75 mcg/kg/min or 1 mcg/kg/min. Twelve patient's doses were titrated to achieve a platelet reactivity unit (PRU) between 50-150; three patient's doses were titrated multiple times. Based on initial PFT results, utilizing the 1 mcg/kg/min maintenance dose resulted in more patients being in the acceptable (10-180) and desired (50-150) PRU range than the 0.75 mcg/kg/min dose (47% vs 56% and 70% vs 80%, respectively). Final recorded PRU results showed that 64% of patients had PRUs in the optimal range (50-150) and 88% of patients had PRUs in the desire range (10-180).
Utilizing low doses of cangrelor with platelet function testing is an option during emergent neuroendovascular stenting and bridging. Cangrelor demonstrates significant variability in response at low doses and exhibits a dose response relationship when PFT is utilized.
对于紧急神经血管支架置入术，最佳的抗血小板治疗方案尚不确定。坎格雷洛是一种静脉内 P2Y12 抑制剂，由于其良好的药代动力学特性和易于测量性，因此是一种有吸引力的选择，但最佳剂量仍不清楚。本研究的主要目的是利用血小板功能检测（PFT）来描述低剂量坎格雷洛（<2μg/kg/min）的剂量反应。
对 2019 年 1 月 1 日至 2020 年 10 月 31 日期间接受坎格雷洛治疗的所有接受介入治疗或桥接治疗的患者进行了回顾性分析。72 名患者符合纳入标准。对基于 PFT 的低剂量坎格雷洛剂量反应进行了深入分析。
接受坎格雷洛治疗的神经血管患者。
奥尔巴尼医疗中心医院。
接受介入治疗的患者给予 5μg/kg 的负荷剂量，初始输注速率为 0.75μg/kg/min 或 1μg/kg/min。接受桥接治疗的患者初始输注速率为 0.75μg/kg/min 或 1μg/kg/min。12 名患者的剂量进行了滴定，以达到血小板反应单位（PRU）在 50-150 之间；3 名患者的剂量进行了多次滴定。根据初始 PFT 结果，与 0.75μg/kg/min 剂量相比，使用 1μg/kg/min 的维持剂量可使更多患者处于可接受（10-180）和理想（50-150）PRU 范围（分别为 47%比 56%和 70%比 80%）。最终记录的 PRU 结果显示，64%的患者 PRU 处于最佳范围（50-150），88%的患者 PRU 处于理想范围（10-180）。
在紧急神经血管支架置入术和桥接术中，使用低剂量坎格雷洛并结合血小板功能检测是一种选择。坎格雷洛在低剂量时表现出显著的反应变异性，并在使用 PFT 时表现出剂量反应关系。
