Potential and Limitations of the New P2Y12 Inhibitor, Cangrelor, in Preventing Heparin-Induced Platelet Aggregation During Cardiac Surgery: An In Vitro Study.

Détails

ID Serval
serval:BIB_863C0ABAEA9C
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Potential and Limitations of the New P2Y12 Inhibitor, Cangrelor, in Preventing Heparin-Induced Platelet Aggregation During Cardiac Surgery: An In Vitro Study.
Périodique
Anesthesia and analgesia
Auteur(s)
Scala E., Gerschheimer C., Gomez F.J., Alberio L., Marcucci C.
ISSN
1526-7598 (Electronic)
ISSN-L
0003-2999
Statut éditorial
Publié
Date de publication
08/2020
Peer-reviewed
Oui
Volume
131
Numéro
2
Pages
622-630
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
Heparin-induced thrombocytopenia (HIT) can put cardiac surgery patients at a high risk of lethal complications. If anti-PF4/heparin antibodies (anti-PF4/Hep Abs) are present, 2 strategies exist to prevent intraoperative aggregation during bypass surgery: first, using an alternative anticoagulant, and second, using heparin combined with an antiaggregant. The new P2Y12 inhibitor, cangrelor, could be an attractive candidate for the latter strategy; several authors have reported its successful use. The present in vitro study evaluated cangrelor's ability to inhibit heparin-induced platelet aggregation in the presence of anti-PF4/Hep Abs.
Platelet-poor plasma (PPP) from 30 patients with functional anti-PF4/Hep Abs was mixed with platelet-rich plasma (PRP) from 5 healthy donors.Light transmission aggregometry was used to measure platelet aggregation after adding 0.5 IU·mL of heparin (HIT) to the plasma, and this was compared with samples spiked with normal saline (control) and samples spiked with cangrelor 500 ng·mL and heparin 0.5 IU·mL (treatment). Friedman test with post hoc Dunn-Bonferroni test was used for between-group comparisons.
Heparin 0.5 IU·mL triggered aggregation in 22 of 44 PPP-PRP mixtures, with a median aggregation of 86% (interquartile range [IQR], 69-91). The median aggregation of these 22 positive samples' respective control tests was 22% (IQR, 16-30) (P < .001). Median aggregation in the cangrelor-treated samples was 29% (IQR, 19-54) and significantly lower than the HIT samples (P < .001). Cangrelor inhibited heparin-induced aggregation by a median of 91% (IQR, 52-100). Cangrelor only reduced heparin-induced aggregation by >95% in 10 of the 22 positive samples (45%). Cangrelor inhibited heparin-induced aggregation by <50% in 5 of the 22 positive samples (22%) and by <10% in 3 samples (14%).
This in vitro study found that cangrelor was an unreliable inhibitor of heparin-induced aggregation in the presence of anti-PF4/Hep Abs. We conclude that cangrelor should not be used as a standard antiaggregant for cardiac patients affected by HIT during surgery. Unless cangrelor's efficacy in a particular patient has been confirmed in a presurgery aggregation test, other strategies should be chosen.
Mots-clé
Adenosine Monophosphate/analogs & derivatives, Adenosine Monophosphate/blood, Adenosine Monophosphate/pharmacology, Anticoagulants/adverse effects, Anticoagulants/blood, Cardiac Surgical Procedures/adverse effects, Cardiac Surgical Procedures/methods, Heparin/adverse effects, Heparin/blood, Humans, Platelet Aggregation/drug effects, Platelet Aggregation/physiology, Purinergic P2Y Receptor Antagonists/blood, Purinergic P2Y Receptor Antagonists/pharmacology, Receptors, Purinergic P2Y12/blood
Pubmed
Web of science
Création de la notice
28/02/2020 13:33
Dernière modification de la notice
12/05/2021 5:34
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