- Question
- Does intravenous platelet inhibition with cangrelor during PCI reduce periprocedural ischemic events compared with an oral clopidogrel loading dose?
- Design
- Phase 3, randomized, double-blind, placebo-controlled (double-dummy) trial enrolling 11145 patients undergoing urgent or elective PCI and receiving guideline-recommended therapy. The primary endpoint was assessed at 48 hours after randomization.
- Population
- Patients undergoing percutaneous coronary intervention, either urgent or elective, including acute coronary syndrome settings.
- Intervention
- Cangrelor as a 30 µg/kg bolus followed by an intravenous infusion of 4.0 µg/kg/min for at least 2 hours or until the end of the procedure, whichever was longer, with the option to extend it to 4 hours.
- Control
- Clopidogrel loading dose of 600 mg or 300 mg, given before or after PCI at the investigator's discretion, together with a placebo infusion to maintain blinding.
- Primary outcome
- Composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours after randomization.
- Results
- The primary endpoint occurred in 4.7% with cangrelor and 5.9% with clopidogrel (adjusted odds ratio 0.78; 95% CI 0.66 to 0.93; P=0.005). Stent thrombosis at 48 hours, the key secondary endpoint, was 0.8% versus 1.4% (odds ratio 0.62; 95% CI 0.43 to 0.90; P=0.01).
- Safety
- Severe bleeding at 48 hours was 0.16% with cangrelor and 0.11% with clopidogrel (odds ratio 1.50; 95% CI 0.53 to 4.22; P=0.44). Transient dyspnea was more frequent with cangrelor (1.2% vs 0.3%).
- Conclusion
- Cangrelor significantly reduced ischemic events, including stent thrombosis, during PCI, without a significant increase in severe bleeding.
- Why it matters
- It showed that a rapid-acting, quickly reversible intravenous antiplatelet agent can reduce periprocedural ischemic complications, offering a useful option when the absorption or timing of oral P2Y12 inhibitors is uncertain.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026