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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/s-0044-1785649
Technical Note

Feasibility and Safety of Bridging Antiplatelet Therapy with Cangrelor in Neuro-Oncology: A Preliminary Experience

Giacomo Bertolini 
1   Neurosurgery Unit, Head and Neck Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
,
Laura Belli
1   Neurosurgery Unit, Head and Neck Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
,
Stefania Mazza
1   Neurosurgery Unit, Head and Neck Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
,
Pietro Tito Ugolotti
2   Department of Surgery, Cardiology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
,
Iacopo Tadonio
2   Department of Surgery, Cardiology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
,
Patrizia Ceccarelli
3   Department of Anesthesiology and Intensive Care Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
,
Sandra Rossi
3   Department of Anesthesiology and Intensive Care Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
,
Salvatore Ippolito
1   Neurosurgery Unit, Head and Neck Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
› Author Affiliations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Antiplatelet therapy is mandatory for prevention of thrombotic events in patients with a recent history of acute coronary syndromes and/or percutaneous coronary interventions. However, if an urgent surgery is required during antiplatelet therapy, a compromise between the ischemic/thrombotic and hemorrhagic risk has to be reached. Different bridging schemes are reported in the literature, but there is no clear consensus on the optimal treatment strategy in terms of efficacy and safety. Although some indications about the perioperative management of antiplatelet therapy regarding specific surgical specializations are available, balancing the thrombotic and hemorrhagic risk on an individual basis, no evidence referring to neurosurgical or neuro-oncologic procedures is reported. Herein, we present our preliminary experience in the perioperative management of a patient who underwent a neurosurgical procedure for the resection of a primary malignant brain tumor using an intravenous P2Y12 inhibitor (cangrelor) as bridging therapy after a recent acute myocardial infarction treated with primary percutaneous coronary intervention and stenting. The oral P2Y12 inhibitor (clopidogrel) was withdrawn 5 days prior to the surgical procedure and continuous infusion of cangrelor was started 3 days before the surgery at a dose of 0.75 μg/kg/min. Cangrelor was discontinued 2 hours before surgery and resumed 72 hours after tumor resection for further 60 hours. Neither cangrelor-related bleeding nor cardiac ischemic events were observed in the perioperative period and the following 90 days, supporting data regarding the feasibility and safety of this bridging scheme. Further studies are needed to confirm our promising results.

Keywords

cangrelor - glioblastoma - antiplatelet therapy - neurosurgery


Publication History

Received: 29 October 2023

Accepted: 06 February 2024

Article published online:
15 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
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