Safety of Intravenous Cangrelor Administered Within 24 hours of Thrombolytics in Patients With Ischemic Stroke and Acute Stenting

Document Type

Conference Proceeding

Publication Date


Publication Title

Neurocrit Care


Background & Purpose Thrombolytics, mechanical thrombectomy, and carotid stenting are frequently utilized for the treatment of acute ischemic stroke. It is recommended not to utilize antithrombotic agents in the immediate 24- hour period after thrombolytic administration for acute ischemic stroke due to perceived bleeding risk. When acute stent placement is needed within 24 hours of thrombolytic administration, antiplatelet agents are needed intra-procedure and post-procedure. Cangrelor is increasingly utilized during acute neuroendovascular stenting but the safety of using cangrelor in the immediate period after thrombolytic administration due to the need for stent placement has not been well studied. Methods Patients who presented with acute ischemic stroke who received a thrombolytic and underwent stent placement and received intravenous cangrelor within 24 hours were retrospectively reviewed. Demographics, procedure details/indications, cangrelor dose, and bleeding outcomes were collected. The European Cooperative Acute Stroke Study (ECASS) and the Heidelberg classification systems were utilized to categorize the severity of intracranial hemorrhage. Results A total of 15 patients met the inclusion criteria. All patients received alteplase and underwent mechanical thrombectomy and required stent placement. Five patients had intracranial hemorrhages that were categorized as Heidelberg hemorrhagic infarction class la or ECASS hemorrhagic infarction class 1. No patients had symptomatic intracranial hemorrhage or an intracranial hemorrhage that demonstrated confluence in the infarction bed or mass effect. Conclusion The utilization of intravenous cangrelor within 24 hours of thrombolytic administration post ischemic stroke in patients who require acute stenting appears to be safe. Comparative studies with a control population are needed to confirm these findings.

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Not assigned.





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