Cangrelor Dosing, Administration, and Clinical Outcomes for Patients Undergoing Complex and High-Risk Percutaneous Coronary Interventions.

Background

Cangrelor reduces thrombotic events in patients undergoing percutaneous coronary intervention (PCI), with the advantage of rapid onset and offset. However, premature discontinuation may increase the risk of acute thrombosis for patients undergoing complex/high-risk PCI (CHIP).

Aims

We evaluated the real-world administration of cangrelor and related health outcomes for CHIP patients.

Methods

A US retrospective physician panel medical chart review (1/1/2020 to 6/26/2025) included patients 18+ years old who received cangrelor (1st dose = index date) during CHIP. We summarized patients' characteristics in the 6 months pre-index (baseline), cangrelor dosing and administration (IV bolus and/or infusion), and clinical outcomes within 48 h. We described MACE occurrence by dosing adherence.

Results

Patients (n = 200) were mostly male (85.5%), had a mean age of 63 years, and had a BMI of 30.2 kg/m2. Most (87.5%) received a cangrelor bolus (30.0 µg/kg) and maintenance infusion (4.0 µg/kg/mins), aligned with intended use recommendations. Of patients analyzed for infusion duration (n = 134), 64.9% deviated from the recommendation of at least 2 h or PCI length. Forty (29.9%) received cangrelor for less than the recommended duration. Overall, 30 (15%) patients experienced MACE, with a higher proportion of MACE seen in those who deviated from the recommended duration (16.1% [95% CI: 3.5%-23.1%] vs. 10.6% [95% CI: 9.1%-25.5%]).

Conclusions

Our study provides real-world insight into cangrelor use and clinical outcomes in CHIP patients, highlighting notable variability in infusion duration and differences in MACE occurrence by dosing adherence. Further comparative effectiveness studies are warranted to examine the potential impact of deviation from intended dose/duration on clinical outcomes in CHIP.