Optimizing Antiplatelet Therapy in Cardiogenic Shock-Data for the Use of Cangrelor in AMI-CS and High-Risk PCI, Dr. Jennifer Rymer

Data for the Use of Cangrelor in AMI-CS and High-Risk PCI, Dr. Jennifer Rymer

Video Transcription

Video Summary

This case presentation discussed a 72-year-old patient with STEMI complicated by cardiogenic shock and heavy thrombus burden. The speaker favored intravenous cangrelor for antiplatelet therapy due to concerns about poor gut absorption of oral P2Y12 inhibitors in shock, mechanical ventilation, and opioid use. Recent studies including the SCAR registry, CAN shock, culprit shock trials, and the DAP shock trial were reviewed. These showed that cangrelor achieved rapid platelet inhibition and was associated with lower rates of major adverse cardiac events (MACE) and mortality, though some primary endpoints missed statistical significance. The speaker’s own registry supported cangrelor’s use especially in high-risk, cardiogenic shock patients, with easier transition to oral agents and comparable bleeding rates. Panelists highlighted challenges in demonstrating survival benefits due to small trial sizes and the low incidence of thrombosis, emphasized the importance of rapid onset/offset of IV cangrelor for bleeding management, and discussed the need for further trials comparing cangrelor to other agents like glycoprotein IIb/IIIa inhibitors. Overall, IV cangrelor is favored for quick, controllable platelet inhibition in complex, unstable AMI patients with cardiogenic shock.

Keywords

STEMI

cardiogenic shock

cangrelor

intravenous antiplatelet therapy

thrombus burden