'%3e%3cline%20id='Line_151'%20data-name='Line%20151'%20x2='29.522'%20transform='translate(22.5%2022.368)'%20fill='none'%20stroke='%23fff'%20stroke-linecap='round'%20stroke-width='4'/%3e%3cline%20id='Line_152'%20data-name='Line%20152'%20x2='29.522'%20transform='translate(22.5%2032.443)'%20fill='none'%20stroke='%23fff'%20stroke-linecap='round'%20stroke-width='4'/%3e%3cline%20id='Line_153'%20data-name='Line%20153'%20x2='29.522'%20transform='translate(22.5%2042.519)'%20fill='none'%20stroke='%23fff'%20stroke-linecap='round'%20stroke-width='4'/%3e%3c/g%3e%3c/svg%3e)
'%20fill='%232c3e50'%20fill-rule='evenodd'/%3e%3c/svg%3e)
'%20d='M14,8a6,6,0,1,0,6,6A6,6,0,0,0,14,8Zm0,10.839A4.839,4.839,0,1,1,18.839,14,4.837,4.837,0,0,1,14,18.839Zm1.5-2.526L13.441,14.82a.292.292,0,0,1-.119-.235V10.613a.291.291,0,0,1,.29-.29h.774a.291.291,0,0,1,.29.29v3.428l1.616,1.176a.29.29,0,0,1,.063.406l-.455.627A.292.292,0,0,1,15.5,16.313Z'%20transform='translate(-8%20-8)'%20fill='%232c3e50'/%3e%3c/svg%3e)
'%20d='M4.1,11.944C.642,6.929,0,6.414,0,4.571a4.571,4.571,0,0,1,9.142,0c0,1.843-.642,2.358-4.1,7.373a.572.572,0,0,1-.94,0Zm.47-5.468a1.9,1.9,0,1,0-1.9-1.9A1.9,1.9,0,0,0,4.571,6.476Z'%20transform='translate(0)'%20fill='%232c3e50'/%3e%3c/svg%3e)
Cangrelor monitoring and dose adaptation allows susbtantial cost saving
Position du problème et objectif(s) de l’étude
Cangrelor, an intravenous P2Y12 inhibitor with rapid onset and quick reversibility could be usefull in neurovascular emergencies requiring antiplatelet therapy. The research aimed to assess safety, efficacy, and cost-effectiveness of dose-adjusted cangrelor using multiple electrode aggregometry (MEA) monitoring.
Matériel et méthodes
In this single-center retrospective study, 25 patients admitted to neurointensive care (December 2021-April 2024) received cangrelor for aneurysmal subarachnoid hemorrhage or ischemic stroke. Treatment began with a 30 μg/kg bolus followed by 4 μg/kg/min infusion, subsequently titrated using MEA measurements targeting platelet aggregation of 190-390 AU.min. Efficacy was defined as absence of thrombosis or ischemia; safety as absence of hemorrhagic events.
Résultats & Discussion
Patients (median age 54 years, predominantly female) received cangrelor for a median of 93 hours. One stent thrombosis occurred without clinical consequence. Eight patients experienced hemorrhagic complications, mostly asymptomatic. The dose-adjustment protocol achieved 72% median drug quantity reduction compared to standard dosing. Dose requirements increased with rising platelet counts during longer infusions. The median cost saving was 71% (€5,402 per patient).
Conclusion
MEA-guided cangrelor dosing provides effective antiplatelet therapy for neurovascular interventions while substantially reducing costs and maintaining safety, even during prolonged administration. Daily monitoring is warranted due to increasing dose requirements with rising platelet counts. Further large studies are needed to confirm these promising results.
Auteurs
Louise PAGÈS (1) , Laurent WEINMANN (2), Gaultier MARNAT (3), Grégoire CANE (1), Matthieu BIAIS (4), Hugues DE COURSON (5) - (1)Département Anesthésie Réanimation, Chu Bordeaux, Bordeaux, France, (2)Hématologie Biologique, Chu Bordeaux, Bordeaux, France, (3)Département Neuro-Radiologie, Chu Bordeaux, Bordeaux, France, (4)Département Anesthésie Réanimation, Chu Bordeaux, Université Bordeaux, Inserm, Bmc, U1034, Bordeaux, France, (5)Département Anesthésie Réanimation, Chu Bordeaux, Université Bordeaux, Inserm, Bph, U1219, Bordeaux, France