Cangrelor use prior to left ventricular assist device surgery: a case series
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Bleeding frequently occurs in patients undergoing placement of a left ventricular assist device (LVAD). Clinical factors that have been identified as contributing to peri-procedural bleeding include LVAD implantation after an acute myocardial infarction and preoperative use of antiplatelet agents. In this report, we describe the use of cangrelor for preoperative antiplatelet bridging to LVAD in five post myocardial infarction patients with cardiogenic shock that had recently undergone percutaneous coronary intervention. During the cangrelor bridging period, no cases of thrombotic or major bleeding events occurred. During the first week following LVAD implantation, two patients experienced a major bleeding (each case required chest exploration for suspected hemorrhage). To our knowledge, this is the first series describing cangrelor use for antiplatelet bridging in patients undergoing LVAD implantation. While this series suggest cangrelor could possibly be a safe and effective antiplatelet bridging strategy, further research is needed to identify the optimal antithrombotic strategy in cardiogenic shock patients undergoing LVAD implantation who have recently undergoing percutaneous coronary intervention.
KeywordsCangrelor Bridging Left ventricular assist device Percutaneous coronary intervention
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Conflict of interest
Dr. DeVore reports research funding from the American Heart Association, Amgen, the National Heart, Lung, and Blood Institute (NHLBI) and Novartis and serving as a consultant for Novartis. Dr. Welsby reports research funding from CSL Behring, Terumo BCT, Zimmer Biomet, Clinical and Translation Research Award and NHLBI.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study (retrospective) formal consent is not required.
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