Real-world study examines cangrelor dosing for antiplatelet bridging after PCI

A multi-center retrospective cohort study examined how cangrelor has been used in real-world clinical practice around the time of surgery following percutaneous coronary intervention (PCI) and described differences in outcomes seen with different dosing approaches. Researchers presented the late-breaking data today at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions & Canadian Association of Interventional Cardiology/Association Canadienne de cardiologie d'intervention (CAIC-ACCI) Summit in Montreal.

Patients with a blocked or narrowed artery often undergo PCI with stent placement to restore blood flow. These patients are often treated with oral antiplatelet medications to reduce the risk of thrombotic events. When subsequent surgery is needed, sometimes it is necessary to interrupt oral antiplatelet therapy to balance bleeding and thrombotic risk. In this situation, clinicians may choose to use an IV antiplatelet medication for bridging, such as cangrelor, during the period leading up to surgery. Cangrelor is a short-acting antiplatelet medication. In clinical practice, it has been used to provide platelet inhibition during periods when oral antiplatelet medications are interrupted. This can occur when a patient undergoes a surgical procedure. Yet, real-world data describing cangrelor use for perioperative antiplatelet bridging following PCI and associated clinical outcomes remain limited. 

Leveraging a network of cardiologists and cardiothoracic surgeons in the U.S., researchers conducted a retrospective chart review (January 2020 to November 2025) of adults who received cangrelor within six months post-PCI for subsequent surgery. Clinical outcomes (major adverse cardiovascular events [MACE], mild, moderate, or severe bleeding events, other complications) were characterized through 72 hours post-surgery or death. Outcomes were summarized overall and by surgery characteristics and infusion rate relative to the dose for bridging as evaluated in a randomized controlled trial (0.75 mcg/kg/min). 

Among 222 patients, 78.4% were male, with a median age of 65 years. Cangrelor infusion rates varied in real-world practice (11.7% received an infusion rate less than 0.75 mcg/kg/min; 61.2% received an infusion rate greater than 0.75 mcg/kg/min). MACE occurred in 8.1% of patients, and mild or moderate bleeding events were uncommon (3.6%). MACE was more frequent among patients undergoing cardiac surgery compared with non-cardiac surgery (11.6% vs. 3.2%) and among patients in whom PCI and surgery occurred during the same admission compared to different admissions (13.3% vs. 0.0%). Across infusion rates, MACE was highest with cangrelor infusion rates less than 0.75 mcg/kg/min (<0.75 mcg/kg/min: 19.2%; 0.75 mcg/kg/min: 6.0%; >0.75 mcg/kg/min: 7.4%). Bleeding events were observed more frequently with higher infusion rates (<0.75 mcg/kg/min: 0.0%; 0.75 mcg/kg/min: 2.0%; >0.75 mcg/kg/min: 5.1%). 

Real-world data demonstrate substantial variability in cangrelor dosing among patients receiving antiplatelet therapy as a bridging strategy prior to surgery. There is a suggestion that dosing patterns may affect outcomes. These findings highlight the need for further research and continued evaluation of dosing patterns and clinical outcomes to improve decision-making in patients requiring bridging intravenous antiplatelet therapy following PCI." 

Akash Garg, MD, FSCAI, Director of cardiac catheterization lab and structural heart interventions at Ellis Hospital in Schenectady, New York

The authors note future studies should evaluate periprocedural dosing and identify high-risk groups to inform bridging strategies.