Comparison of Outcomes in Patients Requiring Mechanical Circulatory Support Who Received Cangrelor in Addition to Anticoagulation Versus Anticoagulation Alone

Objectives To evaluate the safety of cangrelor administered concurrently with heparin or bivalirudin in patients on mechanical circulatory support. Design A single-center, retrospective, cohort study of adult patient consecutively admitted between January 2016 and October 2020 Setting A tertiary medical center. Participants Adult patients admitted to the cardiovascular intensive care unit initiated on mechanical circulatory support for acute myocardial infarction (AMI) or non-AMI indications. Patients who received cangrelor underwent percutaneous coronary intervention with stenting during the index event or within the last year. Interventions None. Measurements and Main Results The primary outcome was the incidence of major bleeding, defined by the Extracorporeal Life Support Organization criteria, in patients with mechanical circulatory support receiving cangrelor plus anticoagulation with heparin or bivalirudin with or without aspirin versus patients who did not receiving cangrelor. Sixty-eight patients were included in the study. Twenty-nine patients received cangrelor and 39 did not. Cangrelor was not associated with an increase in major bleeding, however our confidence interval was wide (adjusted hazard ratio [aHR] 1.93, 95% CI 0.61-6.11; p=0.262). Conclusions Patients receiving cangrelor did not appear to be at higher risk of major bleeding compared to patients not receiving cangrelor. Larger trials should be conducted to better evaluate the safety of cangrelor in patients on mechanical circulatory support.