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In contrast with crushed ticagrelor, intravenous cangrelor offered rapid, efficient platelet inhibition, with no improve in main bleeding and decrease mortality charges in sufferers with acute myocardial infarction and cardiogenic shock, in accordance with late-breaking analysis offered in a Sizzling Line session on the ESC Congress 2025.
Cardiogenic shock is a life-threatening situation through which the guts can’t pump sufficient blood to fulfill the physique’s wants. It’s current in round 4.6% of sufferers admitted to hospital for acute myocardial infarction (MI) and is related to in-hospital mortality charges of 44%. Reperfusion utilizing major percutaneous coronary intervention (PCI) stays the one common therapeutic strategy that improves prognosis.
“Achieving early and effective platelet inhibition is vital for reperfusion at the microcirculatory level in patients with MI complicated with cardiogenic shock,” defined Principal Co-Investigator, Professor Zuzana Motovska from the Charles College and College Hospital Kralovske Vinohrady, Prague, Czechia.
“However, major randomized trials on the efficacy and safety of antiplatelet drugs have not included patients with cardiogenic shock. Currently, oral crushed ticagrelor tablets are given. However, the parenteral, direct-acting, reversible P2Y12 inhibitor, cangrelor, may address issues that occur during cardiogenic shock, including poor absorption and impaired liver metabolism.”
“The DAPT-SHOCK-AMI trial—comparing IV cangrelor with crushed ticagrelor—is the first-ever randomized study evaluating the efficacy and safety of antiplatelet agents in this setting.”
This double-blind, placebo-controlled randomized trial was carried out at 29 websites in Czechia, France, Germany, Poland and Slovakia. Key inclusion standards have been acute MI with a sign for emergency major PCI and cardiogenic shock that fulfilled no less than two of: a) systolic blood stress
Sufferers have been randomized 1:1 to obtain IV cangrelor (IV bolus of 30 μg/kg adopted by a steady infusion at 4 μg/kg) or oral ticagrelor (crushed tablets at a 180-mg loading dose after which a upkeep dose of 90 mg twice day by day). Within the cangrelor group, half-hour earlier than the tip of the cangrelor infusion, 180 mg of ticagrelor (crushed tablets) was administered, adopted by a upkeep dose of 90 mg twice day by day.
Cangrelor-placebo and ticagrelor-placebo have been administered in the identical type as their lively counterparts. The research treatment was administered to all enrolled sufferers on prime of concomitant aspirin. In complete, 605 sufferers have been randomized. The imply age was 65 years and 22.6% have been ladies.
The first laboratory endpoint (outlined as platelet reactivity index
At 30 days, the first medical endpoint was not met: 37.6% of sufferers within the cangrelor group and 41.0% of sufferers within the ticagrelor group skilled all-cause dying, MI or stroke (distinction −3.5%, 95% confidence interval [CI], −11.2% to 4.3%; p for noninferiority=0.13).
The incidence of all-cause mortality at 12 months was 43.6% within the cangrelor group and 49.2% within the ticagrelor group (distinction: −5.6%; 95% CI, −13.5% to 2.4%), whereas the incidence of cardiovascular mortality was 26.8% and 33.2%, respectively ( −6.4%; 95% CI, −13.7% to 0.9%).
The incidence of main bleeding at 30 days was 6.4% within the cangrelor group and 5.2% within the ticagrelor group (p=0.53).
Enhancements have been famous in major PCI outcomes, periprocedural problems, early reinfarction and stent thrombosis charges with cangrelor in contrast with ticagrelor.
Principal Co-Investigator, Professor Deepak Bhatt from the Icahn College of Drugs at Mount Sinai, New York, U.S., concluded, “Compared with crushed ticagrelor, IV cangrelor provided immediate, effective platelet inhibition and improved several secondary and exploratory clinical outcomes without increasing major bleeding. If verified in larger trials, IV cangrelor could represent a major advancement in the treatment of cardiogenic shock.”
Extra data:
Summary: DAPT-SHOCK-AMI trial: Cangrelor in cardiogenic shock
Offered by
European Society of Cardiology
Quotation:
Intravenous blood thinner investigated in cardiogenic shock attributable to acute myocardial infarction (2025, September 1)
retrieved 1 September 2025
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