Experimental Blood Thinner Given Before Surgery Shows Benefit
The intravenous drug cangrelor appears to have the potential to serve as a "bridge" medication for heart patients to take in the several days before procedures such as coronary artery bypass grafting, the study authors reported.
Anti-clotting drugs, also referred to as antiplatelet therapy or anticoagulants -- including clopidogrel, known by the brand name Plavix -- are often given to heart patients to prevent dangerous vessel-clogging blood clots. But they can cause too much bleeding during surgery, and guidelines suggest that doctors stop treatment with them in the five to seven days before an operation.
In the new study, Dr. Dominick Angiolillo of the University of Florida, Jacksonville, and colleagues gave cangrelor or a placebo to 210 patients who were about to undergo coronary artery bypass grafting. The patients had been treated with a thienopyridine (such as Plavix) but went off the drugs prior to surgery as recommended, then received cangrelor or placebo for at least 48 hours until one to six hours before surgery.
Angiolillo's team found that excessive bleeding related to surgery wasn't much more likely in the patients who took the drug (11.8 percent) compared to those who took the placebo (10.4 percent). Major bleeding problems before surgery were rare, while those who took cangrelor had more minor bleeding problems, according to the report published in the Jan. 18 issue of the Journal of the American Medical Association.
The investigators also found that the patients who took cangrelor reached levels of platelet inhibition that are linked to a lower risk of problems such as clots.
The findings make sense, said Dr. Gregg Stone, a heart specialist and professor of medicine at Columbia University in New York City. The study shows that cangrelor works rapidly and then dissipates when it isn't needed anymore so it doesn't boost the risk of bleeding during surgery, he said.
"This drug is investigational, so it is not yet an option for patients to ask about," Stone pointed out, "but if [the U.S. Food and Drug Administration] approved it, it would likely be widely used."
For more about blood thinners, visit the U.S. National Library of Medicine.
Posted: January 2012
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