IV Cangrelor Shows Promise in Treating Heart Attack-Related Shock, Landmark Trial Finds
Prague, Czechia – A first-of-its-kind randomized trial has demonstrated that the intravenous (IV) blood thinner cangrelor rapidly and effectively inhibits platelet activity in patients experiencing cardiogenic shock following a heart attack (acute myocardial infarction, or AMI), and suggests potential benefits in clinical outcomes. The DAPT-SHOCK-AMI trial, conducted across five European countries, compared cangrelor to standard treatment with crushed oral ticagrelor. While the study did not meet its primary clinical endpoint of non-inferiority for a composite of death, heart attack, or stroke at 30 days, it revealed significant improvements in several secondary measures and a trend toward reduced mortality.
Cardiogenic shock, a life-threatening condition where the heart suddenly can’t pump enough blood to meet the body’s needs, often occurs after a severe heart attack. Current guidelines rely on oral antiplatelet medications like ticagrelor, but absorption can be unreliable in critically ill patients. “Major randomised trials on the efficacy and safety of antiplatelet drugs have not included patients with cardiogenic shock,” explained Professor Zuzana Motovska from Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia, a Principal Co-Investigator. “The DAPT-SHOCK-AMI trial…is the first-ever randomised study evaluating the efficacy and safety of antiplatelet agents in this setting.”
The double-blind trial enrolled 605 patients with AMI complicated by cardiogenic shock, requiring emergency primary percutaneous coronary intervention (PCI) – a procedure to open blocked arteries. participants were randomized 1:1 to receive IV cangrelor (a 30 μg/kg bolus followed by a 4 μg/kg infusion) or crushed oral ticagrelor (180mg loading dose, then 90mg twice daily). Those receiving cangrelor also received a subsequent dose of crushed ticagrelor 30 minutes before the infusion ended,followed by the same maintenance dose.All patients also received aspirin. The average age of participants was 65, with women comprising 22.6% of the study population.
Results showed complete platelet inhibition (platelet reactivity index <50%) at the end of PCI in 100% of patients treated with cangrelor, compared to just 22.1% in the ticagrelor group (p<0.0001).At 30 days, 37.6% of the cangrelor group and 41.0% of the ticagrelor group experienced all-cause death, heart attack, or stroke (difference −3.5%, 95% CI −11.2% to 4.3%; p for noninferiority=0.13). However, at 12 months, all-cause mortality was lower in the cangrelor group (43.6%) versus ticagrelor (49.2%; difference: −5.6%; 95% CI −13.5% to 2.4%), and cardiovascular mortality was also reduced (26.8% vs. 33.2%; −6.4%; 95% CI −13.7% to 0.9%). Major bleeding rates were similar between groups (6.4% vs. 5.2%, p=0.53). Notably,cangrelor was associated with improvements in primary PCI outcomes,fewer periprocedural complications,and lower rates of early reinfarction and stent thrombosis. "Compared with crushed ticagrelor, IV cangrelor provided immediate, effective platelet inhibition and improved several secondary and exploratory clinical outcomes without increasing major bleeding," concluded Professor Deepak bhatt from the Icahn School of Medicine at Mount Sinai, New york, USA, also a Principal Co-Investigator. "If verified in larger trials,IV cangrelor could represent a major advancement in the treatment of cardiogenic shock." These findings offer a potential new approach to managing this critical condition,where rapid and reliable antiplatelet therapy is crucial.Further research will be needed to confirm these results and establish cangrelor's role in standard cardiogenic shock treatment protocols.
