http://www.theheart.org/web_slides/1327249.do A study to determine the maintenance of Platelet Inhibition with Cangrelor after Discontinuation of Thienopyridines in Patients Undergoing surgery (BRIDGE)

1. BRIDGE (Maintenance of Platelet
Inhibition with Cangrelor after
Discontinuation of Thienopyridines in
Patients Undergoing Surgery)

2. BRIDGE (Maintenance of Platelet Inhibition with
Cangrelor after Discontinuation of Thienopyridines in
Patients Undergoing Surgery)
D Angiolillo (University of Florida College of Medicine, Jacksonville)
TCT 2011
• Population and treatment:
210 patients with ACS or coronary stents on ticlopidine, clopidogrel, or
prasugrel awaiting CABG
Randomized to continuous infusions of cangrelor (0.75 µg/kg/min) or
placebo for at least 48 hours and within 72 hours of going off the oral
antiplatelets; the infusion was withdrawn one to six hours before CABG
Platelet function monitored by the VerifyNow P2Y12 assay
• Primary outcomes:
Efficacy: Rate of achieving platelet reactivity units (PRU) <240 during the
infusion
Safety: Excessive CABG-related bleeding during the procedure or
subsequent hospitalization

3. BRIDGE: Results (efficacy)
• Significantly more patients on cangrelor than placebo had low levels of platelet
reactivity throughout the entire infusion
• The rate of the primary end point during the infusion was 98.8% for cangrelor and
19.0% among controls (p<0.0001)
Platelet reactivity at baseline and during and after randomized infusion,
in PRU on the VerifyNow system
End point: Mean PRU Cangrelor, n=93 Placebo, n=90 p
Baseline 210.9 214.1 0.817
During infusion 68.9 263.7 <0.001
After end of infusion 279.7 297.8 0.212

4. BRIDGE: Results (safety)
• The primary safety end point didn't differ significantly between the two groups
(p=0.763)
• There was a numerical increase in minor bleeding complications (about 18% vs
10%) among cangrelor recipients
Excessive CABG-related bleeding (during the procedure or after until
discharge)
End point* Cangrelor, n=106 (%) Placebo, n=101 (%) OR (95% CI)
Total CABG-related bleeding 11.8 10.4 1.15 (0.47–2.79)
Surgical reexploration 2.0 2.1 0.94 (0.13–6.81)
24-hour chest-tube output >1.5L 7.8 5.2 1.55 (0.49–4.91)
Incidence of packed RBCs >4 U 5.9 8.3 0.69 (0.23–2.06)
*Defined as occurrence of one or more of the following events during CABG or the postoperative
hospitalization: Surgical reexploration, 24-hour chest-tube output >1.5 L, packed RBC transfusion
>4 units)

5. BRIDGE: Commentary*
"This is the first time we have a trial assessing, in a prospective, randomized,
double-blind fashion, the use of a novel [antiplatelet] agent that has the ideal
properties for bridging. And the trial clearly shows that we are able to achieve and
sustain adequate levels of P2Y12 inhibition during the preoperative stage, with
overall favorable safety signals."
- Dr Dominick Angiolillo
*All comments from BRIDGE to surgery: Cangrelor may safely wean ACS patients off oral antiplatelets
(http://www.theheart.org/article/1306197.do)

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