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. 2023 Nov 27;3(2):101202.
doi: 10.1016/j.jscai.2023.101202. eCollection 2024 Feb.

Risk of Bleeding Among Cangrelor-Treated Patients Administered Upstream P2Y12 Inhibitor Therapy: The CAMEO Registry

Jennifer Rymer  1   2 , Brooke Alhanti  2 , Steven Kemp  2 , Deepak L Bhatt  3 , Ajar Kochar  3 , Dominick J Angiolillo  4 , Miguel Diaz  5 , Kirk N Garratt  6 , Neil J Wimmer  6 , Ron Waksman  7 , Ajay J Kirtane  8 , Lawrence Ang  9 , Richard Bach  10 , Colin Barker  11 , Ronald Jenkins  12 , Mir B Basir  13 , Alex Sullivan  11 , Hijrah El-Sabae  14 , Leo Brothers  2 , E Magnus Ohman  2 , W Schuyler Jones  1   2 , Jeffrey B Washam  2 , Tracy Y Wang  2
Affiliations

Risk of Bleeding Among Cangrelor-Treated Patients Administered Upstream P2Y12 Inhibitor Therapy: The CAMEO Registry

Jennifer Rymer et al. J Soc Cardiovasc Angiogr Interv. .

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Soc Cardiovasc Angiogr Interv. 2025 Aug 9;4(10Part A):103930. doi: 10.1016/j.jscai.2025.103930. eCollection 2025 Oct. J Soc Cardiovasc Angiogr Interv. 2025. PMID: 41268087 Free PMC article.

Abstract

Background: Little is known about the bleeding risk associated with cangrelor use in patients with myocardial infarction (MI) who are exposed to an oral P2Y12 inhibitor before coronary angiography.

Methods: Cangrelor in Acute MI: Effectiveness and Outcomes (CAMEO) is an observational registry studying platelet inhibition for patients with MI. Upstream oral P2Y12 inhibition was defined as receipt of an oral P2Y12 inhibitor within 24 hours before hospitalization or in-hospital before angiography. Among cangrelor-treated patients, we compared bleeding after cangrelor use through 7 days postdischarge between patients with and without upstream oral P2Y12 inhibitor exposure.

Results: Among 1802 cangrelor-treated patients with MI, 385 (21.4%) received upstream oral P2Y12 inhibitor treatment. Of these, 101 patients (33.8%) started cangrelor within 1 hour, 103 (34.4%) between 1 and 3 hours, and 95 (31.8%), >3 hours after in-hospital oral P2Y12 inhibitor administration; the remaining received an oral P2Y12 inhibitor before hospitalization. There was no statistically significant difference in rates of bleeding among cangrelor-treated patients with and without upstream oral P2Y12 inhibitor exposure (6.5% vs 8.8%; adjusted odds ratio [OR], 0.62; 95% CI, 0.38-1.01). Bleeding was observed in 5.0%, 10.7%, and 3.2% of patients treated with cangrelor <1, 1 to 3, and >3 hours after the last oral PY12 inhibitor dose, respectively; bleeding rates were not statistically different between groups (1-3 hours vs <1 hour: adjusted OR, 2.70; 95% CI, 0.87-8.32; >3 hours vs <1 hour: adjusted OR, 0.65; 95% CI, 0.15-2.85).

Conclusions: Bleeding risk was not observed to be significantly higher after cangrelor treatment in patients with and without upstream oral P2Y12 inhibitor exposure.

Keywords: P2Y12 inhibitor; bleeding; cangrelor; myocardial infarction.

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Figures

None
Graphical abstract
Central Illustration
Central Illustration
Schema of study design of real-world use of upstream oral P2Y12 inhibitors before cangrelor administration at the time of coronary angiography. To treat patients with upstream oral P2Y12 inhibitors, they can be administered within 24 hours of hospital admission or in-hospital administration of a P2Y12 inhibitor before coronary angiography. In addition, coronary angiography had to be started within 24 hours of admission (with home use of a P2Y12 inhibitor) or within 24 hours after in-hospital administration of an oral P2Y12 inhibitor. The illustration describes the bleeding outcomes.
Figure 1
Figure 1
Factors associated with upstream use of an oral P2Y12inhibitor among cangrelor-treated patients. Patients treated with cangrelor and an upstream oral P2Y12 inhibitor treatment were more likely to be from an underrepresented racial or ethnic group (UREG) or to have private health insurance. In addition, patients treated with cangrelor and an upstream oral P2Y12 inhibitor treatment were more likely to present with ST segment–elevated myocardial infarction (STEMI), undergo femoral artery access, have had a previous percutaneous coronary intervention (PCI), or have experienced peripheral artery disease (PAD) compared with cangrelor-treated patients without upstream pretreatment. An odds ratio (OR) of >1 is likely to be associated with pretreatment and an OR of <1 is likely not be associated with pretreatment.
Supplemental Figure
Supplemental Figure
See this image and copyright information in PMC

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