与糖蛋白IIb/IIIa抑制剂相比，坎格雷洛在血管内血栓切除术中的安全性和有效性。

Safety and efficacy of cangrelor in endovascular thrombectomy compared with glycoprotein IIb/IIIa Inhibitors.

作者信息

Devarajan Alex, Gottiparthi Shouri, Caton Michael T, Ouf Aya, Wu Katty, Goldman Daryl, Davis Nicole, Musallam Nadine, Zhang Jack, Rao Naina, Dangayach Neha, Davy Connor, Fara Michael G, Majidi Shahram, Oxley Thomas, Kellner Christopher Paul, Shigematsu Tomoyoshi, De Leacy Reade Andrew, Mocco J, Fifi Johanna T, Shoirah Hazem

机构信息

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

出版信息

J Neurointerv Surg. 2025 Jun 1;17(e2):e320-e325. doi: 10.1136/jnis-2024-022228.

DOI:10.1136/jnis-2024-022228

PMID:39481883

Abstract

BACKGROUND

Cangrelor, an intravenous P2Y12-receptor inhibitor, is a reversible and short-acting antithrombotic medication non-inferior to irreversible glycoprotein IIb/IIIa inhibitors (GPIs) like eptifibatide. There are insufficient data to compare the medications in endovascular thrombectomies (EVTs) requiring emergent platelet inhibition.

OBJECTIVE

To review our institution's experience with cangrelor in EVT and compares its safety and efficacy against GPIs.

METHODS

A large healthcare system retrospective review identified all patients who had received cangrelor or eptifibatide intraoperatively during EVT between December 2018 and March 2023 for this cohort study. Clinical data were reviewed. Functional status was defined by the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) at multiple time points. Multivariate regression was performed.

RESULTS

Of 1010 EVT patients, 36 cangrelor and 104 eptifibatide patients were selected. There were no differences in baseline function or presentations. Cangrelor was frequently administered for stenting tandem occlusions (n=16, 44.4%), and successful reperfusion occurred in 30 (83.3%) patients. On multivariate analysis, cangrelor was associated with decreased odds of hemorrhagic conversion (adjusted OR (aOR)=0.76, P=0.004) and symptomatic hemorrhage (aOR=0.86, P=0.021). There were no differences in thrombotic re-occlusion. Cangrelor was associated with a lower 24-hour NIHSS score (7.0 vs 12.0, P=0.013) and discharge NIHSS score (3.0 vs 9.0, P=0.004). There were no differences in in-hospital mortality or length of stay. Cangrelor was associated with improved odds of favorable outcome, defined as mRS score 0-2, at discharge (aOR=2.69, P=0.001) and on 90-day follow-up (aOR=2.23, P=0.031).

CONCLUSION

Cangrelor was associated with a decreased risk of hemorrhagic conversion and might lead to favorable functional outcomes for patients during hospitalization in comparison with GPIs. Prospective studies are warranted to investigate its use in EVT.

摘要

背景

坎格雷洛是一种静脉注射的P2Y12受体抑制剂，是一种可逆的短效抗血栓药物，不比依替巴肽等不可逆糖蛋白IIb/IIIa抑制剂（GPI）差。在需要紧急抑制血小板的血管内血栓切除术（EVT）中，比较这些药物的数据不足。

目的

回顾我们机构使用坎格雷洛进行EVT的经验，并将其安全性和有效性与GPI进行比较。

方法

一项大型医疗系统回顾性研究确定了2018年12月至2023年3月期间在EVT术中接受坎格雷洛或依替巴肽治疗的所有患者，用于本队列研究。对临床数据进行了回顾。在多个时间点通过改良Rankin量表（mRS）和美国国立卫生研究院卒中量表（NIHSS）定义功能状态。进行了多变量回归分析。

结果

在1010例EVT患者中，选择了36例使用坎格雷洛和104例使用依替巴肽的患者。基线功能或表现无差异。坎格雷洛常用于串联闭塞支架置入术（n = 16，44.4%），30例（83.3%）患者实现了成功再灌注。多变量分析显示，坎格雷洛与出血转化几率降低相关（调整后比值比（aOR）= 0.76，P = 0.004）和症状性出血相关（aOR = 0.86，P = 0.021）。血栓再闭塞无差异。坎格雷洛与较低的24小时NIHSS评分（7.0对12.0，P = 0.013）和出院时NIHSS评分（3.0对9.0，P = 0.004）相关。住院死亡率或住院时间无差异。坎格雷洛与出院时（aOR = 2.69，P = 0.001）和90天随访时（aOR = 2.23，P = 0.031）良好预后几率改善相关，良好预后定义为mRS评分0 - 2。