{"id":15403,"date":"2012-01-18T12:01:14","date_gmt":"2012-01-18T17:01:14","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=interventional&p=15403"},"modified":"2012-01-18T12:58:38","modified_gmt":"2012-01-18T17:58:38","slug":"cangrelor-and-alaska%e2%80%99s-%e2%80%9cbridge-to-nowhere%e2%80%9d","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/01\/18\/cangrelor-and-alaska%e2%80%99s-%e2%80%9cbridge-to-nowhere%e2%80%9d\/","title":{"rendered":"Cangrelor and Alaska\u2019s \u201cBridge to Nowhere\u201d"},"content":{"rendered":"

The Gravina Island Bridge (also known as The Bridge to Nowhere<\/em>) was a proposed bridge to replace the ferry that currently connects Ketchikan, Alaska (population, 14,000) to the Ketchikan International Airport on Gravina Island (population, 50) at a projected cost of $398 million.\u00a0The bridge was to have been nearly as long as the Golden Gate Bridge and taller than the Brooklyn Bridge.<\/p>\n

A study published yesterday<\/a>, entitled \u201cBridging Antiplatelet Therapy With Cangrelor in Patients Undergoing Cardiac Surgery,\u201d showed that in patients who discontinue thienopyridine therapy before cardiac surgery, the use of cangrelor compared with placebo resulted in a higher rate of maintenance of platelet inhibition, as assessed with the VerifyNow P2Y12<\/sub> platelet assay. (See also our CardioExchange news coverage here<\/a>.)<\/p>\n

Cangrelor, an intravenously administered P2Y12<\/sub> receptor antagonist with a rapid offset effect (half\u00a0 life, 3-6 minutes), was used to \u201cbridge\u201d patients to surgery after irreversible platelet P2Y12<\/sub> inhibitors (i.e., clopidogrel or prasugrel) were discontinued.\u00a0Cangrelor infusion was initiated a median of 29 hours (IQR, 11-38) after thienopyridines were discontinued and was administered for up to 7 days until shortly (1-6 hours) before surgical incision. Cangrelor was associated with\u00a0a numerical increase in minor, but not major, bleeding before CABG, and with no increase in CABG-related bleeding events.<\/p>\n

What\u2019s the connection<\/strong>?<\/p>\n

It is\u00a0the rare person who flies from Ketchikan\u2026or experiences a serious ischemic event\u00a0after cessation of clopidogrel 5 days before CABG.\u00a0As a result, the benefits of the Alaskan bridge — and of bridging antiplatelet therapy with cangrelor — are unlikely to justify its cost.\u00a0Both the bridge to Gravina Island and the VerifyNow platelet assay are models in search of rationales.\u00a0Certainly, we can build (or perform) it, but does it have a meaningful impact?<\/p>\n

In your patients referred for CABG, do you need to give \u201cbridging antiplatelet therapy?\u201d\u00a0 <\/em><\/strong><\/p>\n

If so, when and how often?<\/em><\/strong><\/p>\n

Would you support the approval of cangrelor for \u201cbridging therapy\u201d?<\/em><\/strong><\/p>\n

\u00a0<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

The Gravina Island Bridge (also known as The Bridge to Nowhere) was a proposed bridge to replace the ferry that currently connects Ketchikan, Alaska (population, 14,000) to the Ketchikan International Airport on Gravina Island (population, 50) at a projected cost of $398 million.\u00a0The bridge was to have been nearly as long as the Golden Gate […]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20,9],"tags":[1111,1106,739,1107,565],"class_list":["post-15403","post","type-post","status-publish","format-standard","hentry","category-cardiac-surgery","category-interventional-cardiology","tag-bridge-trial","tag-cangrelor","tag-cardiac-surgery-2","tag-thienopyridines","tag-verifynow"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/15403","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=15403"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/15403\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=15403"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=15403"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=15403"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}