D265 - Perioperative Cangrelor in a Lung Transplant Patient with Recent Percutaneous Coronary Intervention: A Case Report

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Author Block: E. Kincaide, H. Keyt, A. Aubin, E. Sako, J. Gauthier, University Health Transplant Institute, San Antonio, TX
*Purpose: A 57-year-old male with connective tissue disease-associated interstitial lung disease and a history of 2-vessel coronary artery disease underwent percutaneous coronary intervention (PCI) with three stents. He was initiated on dual antiplatelet therapy (DAPT), with aspirin and ticagrelor, for an intended duration of 6 to 12 months. Four months into DAPT, his respiratory status decompensated necessitating urgent listing for lung transplant before completion of DAPT.
*Methods: The patient was activated on the lung transplant wait list and admitted for a ticagrelor washout and cangrelor initiation at 0.75 mcg/kg/minute as a planned bridge to transplantation. Cangrelor is an intravenous P2Y₁₂ inhibitor that reversibly binds to the P2Y₁₂ receptor, thereby inhibiting platelet activation and aggregation. It has an FDA-approved indication for PCI and is used off-label for bridging therapy for patients requiring urgent cardiothoracic surgery.
*Results: Four days after cangrelor initiation, an organ offer was accepted and the patient received a bilateral lung transplant 7 days after cangrelor was started. Cangrelor was held approximately 12 hours prior to surgery and resumed 48 hours postoperatively. His postoperative course was remarkable for a non-occlusive right internal jugular thrombus detected on screening ultrasound per center-specific protocol. The patient was discharged from index hospitalization on postoperative day 10 on therapeutic enoxaparin and clopidogrel; aspirin was held.
*Conclusions: To date, no published cases have described cangrelor use as bridging therapy in lung transplant. This case demonstrates the feasibility of cangrelor as a bridging therapy in lung transplant for recipients requiring DAPT. The risk of bleeding versus thrombotic events must be carefully considered when managing antiplatelet therapy in this complex patient population.