Safety outcomes with cangrelor versus eptifibatide in patients undergoing periprocedural bridging
Angkear Khorn, Matt Bibb, Kelley Baxter
Ascension Saint Thomas Hospital West, TN
Objective: Evaluate the safety of cangrelor versus eptifibatide for periprocedural IV bridging in cardiac surgery patients focusing on bleeding risk categorized by the Global Use of Strategies to Open Occluded Arteries (GUSTO) criteria
Self Assessment question: Does the choice of IV bridging agent (cangrelor or eptifibatide) impact bleeding risk in patients undergoing periprocedural cardiac procedures?
Background/purpose: Periprocedural bridging with intravenous (IV) antiplatelet agents is essential for patients undergoing cardiac surgery to prevent thrombotic events while minimizing bleeding risks. Cangrelor and eptifibatide are commonly used IV bridging agents, but limited data directly compare their safety profiles. This study evaluates the bleeding risk associated with both agents using the GUSTO criteria and assesses secondary outcomes, including transfusion requirements, hospital length of stay, and cost.
Methodology: This study was a single-center retrospective chart review conducted at Ascension Saint Thomas Hospital West (ASTHW) to evaluate the safety outcomes of cangrelor versus eptifibatide in patients undergoing periprocedural bridging for cardiac procedures. The study included patients who received eptifibatide between July 22, 2018, and July 21, 2021, and those who received cangrelor between July 22, 2021, and July 21, 2024. Patients were included if they required intravenous bridging with either agent for a planned cardiac procedure. Exclusion criteria included patients with a documented allergy to either agent, those receiving the medication for indications other than cardiac bridging, pregnant individuals, and incarcerated patients. The primary outcome assessed was the incidence of bleeding events classified using the GUSTO criteria, while secondary outcomes included transfusion requirements, post-bridge length of stay, bridging duration, and cost analysis.
Results: A total of 268 patients were screened, with 66 meeting the inclusion criteria (31 in the eptifibatide group and 35 in the cangrelor group). Baseline characteristics were similar between groups, with a slightly higher proportion of male patients in the cangrelor group (78%) compared to the eptifibatide group (69%), but no significant differences in age, renal function, comorbidities, or types of cardiac procedures. There was no significant difference in bleeding events between the two groups as assessed by the GUSTO criteria. Secondary outcomes showed that transfusion requirements were higher in the eptifibatide group (42%) compared to the cangrelor group (20%), though this difference did not reach statistical significance (p = 0.053). The median post-bridge hospital length of stay was similar between groups, with cangrelor patients staying a median of 4 days (IQR 5-12) and eptifibatide patients staying 2 days (IQR 1-6, p = 0.884). Bridging duration was also comparable, with a median of 3 days (IQR 2-4) for cangrelor and 2 days (IQR 1-2) for eptifibatide (p = 0.180). However, cost analysis revealed a significant difference, with cangrelor being substantially more expensive per patient (median $3,797, IQR $1,145-$5,727) compared to eptifibatide ($1,847, IQR $938-$2,345, p = 0.0043).
Conclusions: In this study, we observed that cangrelor and eptifibatide had no significant difference in bleeding outcomes for periprocedural cardiac bridging. Both agents showed similar bridging durations and hospital stays, though cangrelor was significantly more expensive. While eptifibatide had a trend toward higher transfusion requirements, it was not statistically significant. Cost considerations should guide agent selection and further prospective studies are needed to validate these findings.
Moderators 
Cardiology Clinical Pharmacist, PGY1 RPC, Wellstar MCG Health
I graduated from UGA College of Pharmacy and then completed a PGY1 residency at UNC REX Healthcare in Raleigh, NC and completed a teaching certificate from UNC Eshelman School of Pharmacy. I then completed a PGY2 Cardiology Residency at the University of Kentucky HealthCare in Lexington...
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PGY1 Pharmacy Resident, Ascension Saint Thomas hospital west
PGY1 Pharmacy Resident at Ascension Saint Thomas Hospital West
Residency Program Director, Cardiovascular Clinical Pharmacist, St Dominic Jackson Memorial Hospital
I am the Residency Program Director and Cardiovascular Clinical Pharmacist at St Dominic Hospital in Jackson, MS. I am originally from Oberlin, Ohio. I graduated from Ohio Northern University. I completed a Pharmacy Practice Residency at Johns Hopkins Hospital in Baltimore...
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